What is female stress incontinence?

What is female stress incontinence?

Female stress incontinence (SUI) is involuntary leakage of urine during times of activity.

It often occurs when doing exercise such as running, jumping or walking but can also occur from coughing or sneezing or simply from bending over or moving from a seated to standing position.

How is female stress incontinence usually treated?

There are conservative measures and surgical options to treat female stress incontinence. There are no medical therapies that work.

Conservative measures involve quitting smoking, weight loss and targeted pelvic floor muscle training.

Targeted pelvic muscle training should be taught by a trained physiotherapist, ideally using biofeedback techniques. This permits the patient to learn which muscle to contract and how to do the exercises.

What does surgery to treat female stress incontinence consists of?

There are four surgical options to treat female SUI.

The simplest option is intraurethral bulking agents. This usually involves a general anaesthetic and using a telescope, injecting a bulking agent into the water pipe to compress the urethra (waterpipe). This can be repeated a second time.

Compressive options include a pubovaginal sling and colposuspension. The sling option uses a short 6cm strip of fascia from the patient’s tummy wall. This sling is then placed under the urethra (via a vaginal incision) and then pulled up behind the pubic bone to support/compress the urethra.

A colposuspension involves a cut to the lower tummy, dissecting tissue behind the pubic bone, then placing sutures on the inside of the vagina either side of the urethra and then pulling these sutures up and stitching them to the inside of the pubic bone. This pulls the upper part of the vagina up, supporting and compressing the urethra.

Another option is a female artificial urinary sphincter. This surgery involves placing a controllable valve device around the urethra called the cuff that is connected to a pump that sits in the labia. The cuff compresses the urethra and when the patient wants to void, they press the labial pump. The labial pump opens the urethral cuff, allowing them to void. After 90 seconds, the cuff closes on its own in order to make the patient continent again.

What advantages does surgery have over other treatments?

Pelvic floor muscle training does work, however, for the majority of patients, in the long term, it does not provide an effective long-lasting solution.

Surgery can provide a permanent effective cure for the urinary incontinence.

Is surgery recommended for every woman who suffers from stress incontinence?

Patients who have problematic SUIs normally try surgery after they have tried conservative measures. Once they have had appropriate bladder pressure tests (urodynamics), most patients are suitable for surgical treatment of their urinary incontinence.

Occasionally, if a patient is very obese or has multiple significant medical problems, the risks of surgery may outweigh the benefits, therefore surgery should be avoided.

Does the surgery have any risks or possible complications?

Like any surgical procedure, surgery for female stress incontinence has risks. It is very important that the patient weighs up those risks and then with support, they should weigh up the benefits versus the risks to determine if they wish to proceed with surgery.

Bulking agents have the lowest risks but also have the lowest chance of success. The bulking agent can also migrate and can cause problems in the bladder and urethra.

Pubovaginal slings can cause symptoms of an overactive bladder and permanent urinary retention.

Colposuspensions can also cause symptoms of an overactive bladder and permanent urinary retention but may also cause the back wall of the vagina to become weak, causing a prolapse (rectocoele).

The female artificial urinary sphincter opens to allow the patient to void and as a result, it has the lowest chance of retention. It also has risks of causing symptoms of an overactive bladder. The device also has a low chance of eroding into the waterpipe or vagina and becoming infected.

If you would like to know more about female stress incontience, you can follow this link: Incontinence of urine | The British Association of Urological Surgeons Limited (baus.org.uk)