Urinary Incontinence - Minor Procedures Solves The Problem

Pictured: Seth M. Rubin, MD, FACOG

Published May 18, 2009

Women commonly develop urinary leakage after delivering their children.  Leakage causes many unpleasant daily experiences, including the frequent need for pads, hygiene issues, and embarrassment.  In the past, treatment of urinary incontinence required significant operations and a long recuperation.  Hence, women suffered with their urinary incontinence symptoms rather than seeking a cure.  A new procedure called a tension free transvaginal tape procedure (TVT procedure) offers correction of urine leakage in almost all patients, with a minor procedure and rapid recovery.  Finally, women no longer need to suffer with unpleasant urinary incontinence symptoms.  My partners and I are pleased to offer the TVT procedure to our patients at the Hunterdon Medical Center. 

Urinary control for women is related to the position of the bladder.  Childbirth results in a great amount of stress on the pelvic structures as the infant descends the birth canal.  Due to the stretching of the pelvic support structures with childbirth, the bladder tends to drop down into the pelvis, and as the bladder drops urinary control worsens.  Poor urinary control due to poor support is often manifested as leakage with coughing, sneezing, laughing or any activity that increases pressure within the abdomen. 

Women who have urine leakage should definitely be seen by their gynecologist for evaluation.  A routine gynecologic evaluation can often help determine whether urine loss is due to poor support.  Sometimes, the office evaluation helps to determine that urine leakage is related to other minor problems that can be treated with medication.  However, for the majority of women who have leakage that starts after childbearing, the problem relates to poor support.

Urinary leakage related to poor support sometimes can be improved by frequent vaginal exercises throughout the day to tense the vaginal muscles to improve support (aka Kegel’s exercises).  In addition, many women learn to empty the bladder prior to engaging in athletic activities or other activities where leakage is common. 

However, some women with more significant pelvic support defects continue to have significant and bothersome urinary leakage in spite of those approaches.  For those women, the next step is bladder testing called urodynamics, where a small tube is placed in the bladder and the bladder is filled with water and tested as it is filled.  Urodynamic evaluation can help determine whether the reason for leakage is truly related to poor pelvic support or related to other issues.

If a woman’s urinary leakage symptoms are proven to be related to poor support, so called genuine stress urinary incontinence, then a minor TVT procedure can be considered.  The TVT procedure is done in an operating room and under anesthesia.  The procedure generally takes less than 30 minutes.  Three tiny incisions are used, one in the vagina and two in the groin, to place a special mesh to raise the bladder into a normal position.  The mesh is a small piece of soft fabric measuring approximately half an inch by three inches, and it remains in place to correct the bladder neck support permanently.  Patients are not able to feel the mesh, and do not even know it is there.

Because the incisions are small and the procedure is minor, most women have no discomfort whatsoever within one week of the procedure.  Patients often return to work within a week, but cannot participate in more strenuous activities for several weeks in order for the procedure to heal strongly and provide a long-term correction of urinary leakage.  The procedure is low in risk and causes minimal discomfort, and the success rates are very high with nearly nine out of ten women having long-term improvement in bladder control. 

So, if you have put up with urinary leakage since delivering your children, you no longer need to continue to suffer with unpleasant symptoms of urinary leakage.  I strongly recommend that you visit a gynecologist skilled in the latest procedures to improve urinary incontinence.  Whereas sometimes medications and lifestyle changes can help improve urine leakage, for some women a minor procedure such as a TVT procedure can provide long-term relief of urinary incontinence with minimal risk and a quick return to your normal lifestyle.

Seth M. Rubin, MD, FACOG Practices with Advanced Obstetrics and Gynecology in Lebanon and Flemington, NJ.  To schedule an appointment with Dr. Rubin call 908-806-0080.  Dr. Rubin is affiliated with the Hunterdon Medical Center and Hunterdon Healthcare Partners.