Urinary incontinence (UI) is the occurrence of any involuntary leakage of urine. It is a common and socially debilitating problem that has a negative impact on general quality of life. It can be clinically divided into three types of urinary incontinence: stress, urge and mixed. Stress urinary incontinence is due to effort, exertion, coughing or sneezing, all of which increase intraabdominal pressure. Stress incontinence can be caused by childbirth, weight gain or other conditions that stretch the pelvic floor muscles. When these muscles cannot properly support the bladder, especially when intraabdominal pressure increases (for example, while coughing), the bladder drops down and pushes against the vagina and urine may leak because of the extra pressure on the bladder. Urge urinary incontinence is characterized by a sudden, urgent need to urinate, which is often referred to as overactive bladder. Mixed urinary incontinence is a combination of stress urinary incontinence and urge urinary incontinence.
Urinary incontinence affects up to 55% of all women, and among these 50% to 80% are identified as having stress urinary incontinence. An estimated 4% to 10% of women in the United States undergo surgery to restore continence, and this rate has increased steadily during the past 20 years. Additionally, it is commonly assumed by healthcare professionals that UI is an underreported condition, so the actual incidence rate may be much higher.
Current treatment options include pharmaceutical, nonsurgical and surgical treatments. Pharmaceutical treatments with medications are effective for urge incontinence and overactive bladder, but generally do not improve stress urinary incontinence. Nonsurgical options include external appliances (for example, adult diapers) for urine collection, behavior modification and pelvic floor exercises. Multiple surgical tissue and suture plication procedures for relieving stress urinary incontinence have been introduced, and although most stabilize the bladder neck and/or urethra, they are not always successful nor are they without complications. Before the 1990s, surgical procedures were invasive and required long periods of recovery. In 1996, the minimally invasive tension-free vaginal tape (TVT) midurethral sling procedure was introduced. In the TVT procedure, a thin ribbon of synthetic material (sling) is delivered through the retropubic space (the space between the vagina and the lower abdomen behind the pubic bone) either from the vagina upward (that is, “bottom up” or “transvaginal”) or from the suprapubic area downward (that is, “top-down” or “suprapubic”). Following the TVT, in 2001, an alternate route via the obturator foramen (an opening in the pelvic bone) using the outside-in approach was introduced, using the transobturator tape midurethral sling. The retropubic and transobturator midurethral slings are the gold standard of care in the treatment of stress urinary incontinence with high success rates and low incidence of complications. Both have been well studied and approved by the FDA for the treatment of stress urinary incontinence.
Female urinary incontinence is a special interest of Washington University urologists, who treat the condition at both Barnes-Jewish West County Hospital and Barnes-Jewish Hospital. They offer women who have incontinence, urgency, frequent urination or bladder pain a range of nonsurgical and surgical options.