Women: Know the Facts about Treatments for Urinary Disorders
It’s a problem that many women live with every time they laugh, cough or sneeze – or put off going to the restroom too long.
Leaking urine – or urinary incontinence – is a medical condition that one in nine women will experience in their lifetime, and the incidence increases with age.
“Many women just put up with it out of embarrassment, or in thinking it’s just something that happens to women as they get older,” said Dr. Matthew Barker, fellowship trained urogynecologist with Avera Medical Group Urogynecology. What’s more, some surgical techniques used to treat this condition are in the news for causing harmful side effects, making some women feel fearful or unsure if they want surgery.
Dr. Barker says there are different surgical options, and the “first line” surgical treatment does not involve the use of synthetic transvaginal mesh material, which has been linked to serious complications.
These surgical procedures treat what’s called pelvic organ prolapse, which is the medical term for when part of the bowel, bladder or uterus falls down into the vagina.
“All these tissues sit on a bowl of muscles in the pelvis,” Dr. Barker said. “These are the muscles that contract when you sneeze, cough or laugh. They are also the muscles that get stretched during childbirth.” There’s also a network of connective tissue in this region that provides support.
It’s this stretching or damage to these muscles that can potentially lead to pelvic organ prolapse. Symptoms include urinary incontinence, overactive bladder, urgency and frequency, fecal incontinence, constipation, pelvic pain, pelvic pressure or painful intercourse. “All are interrelated, because they all involve the muscles, organs and structure of the female pelvis,” Dr. Barker said.
One common surgical technique is to go in through the vagina, create an incision, and tie connective tissue together to create scar tissue and rebuild structure to hold pelvic organs in place.
Use of synthetic mesh to rebuild this structure was introduced in the 1990s. However, reports of complications have caused the FDA to warn of possible side effects such as chronic pain and sexual dysfunction. Some women have also experienced infections and bleeding. “This mesh is a permanent material that is placed inside you that may cause complications affecting your quality of life,” Dr. Barker said. Placing the mesh through abdominal incisions is safer than transvaginally, he added.
Dr. Barker says these warnings should not cause women excessive worry if they have already had a transvaginal mesh procedure – as long as they’re not having any pain or difficulty.
It’s important to realize that there are different types of mesh used for different purposes that have different outcomes. For example, synthetic mesh in the form of mid-urethral slings is used to treat stress urinary incontinence, Dr. Barker said. This is the standard of care, and research shows that these slings are safe and effective for this use. Stress incontinence is caused by a poorly supported urethra. When the surrounding tissues can’t keep it closed, it leaks urine when the woman laughs, coughs or exercises.
There are also non-surgical treatment options for these disorders, including medications, pelvic exercises, physical therapy and biofeedback.
Treatment for urinary incontinence is a quality of life decision. “No one dies of this disorder – it’s all about helping women live to their full potential,” Dr. Barker said. Yet women should talk with their physician about all surgical options, and be assured that the procedure they plan to undergo is safe, without risk of harmful or even deadly side effects, he added.
For more information, go to www.AveraUrogyn.org, or call (605) 322-6700 or toll free 866-996-6980.