Urinary Incontinence Solutions [Emily Abele]

My name is Emily Abele, and I am an OB/GYN here at Avera Medical Group and work at Brookings Health System.

What is urinary incontinence?

Urinary incontinence is involuntary loss of urine from whatever cause that might be. So that can be with things like laugh, cough, sneeze. In the category of stress incontinence can also be with urge. So, when you get the urge to go to the bathroom, can't make it to the bathroom in time to empty your bladder without leaking.

How common is urinary incontinence?

It is much more common than you probably realize. So young women who have never had children about 25% of them will experience some sort of urinary incontinence. Women who are still in their premenopausal stage, but who have had children, the range is somewhere in the 40% to 50% will experience urinary incontinence. And then probably over 75% of postmenopausal women will experience some sort of urinary incontinence in their lifetime. It's not anything that you should necessarily feel embarrassed about because it's very common. It's not something that you can necessarily control. Even if you do all of the right things, it can still happen.

What causes urinary incontinence?

A big factor that contributes specifically to stress incontinence is pregnancy and childbearing. Even with having cesarean sections that doesn't necessarily mean that there hasn't been stretching and damage to our pelvic floor, ligaments and muscles that make it more common that we get urinary incontinence.

How does urinary incontinence affect everyday life?

A lot of women who have urinary incontinence have issues with being able to go out in public whether it's because they don't feel like they want to have to wear a pad and then get their clothes wet in the process of trying to do their errands or they overflow their pad if they are out and about. So it can definitely impact them in that way. And even just the act of having to change a pad or change your underwear in the course of a day can be very stressful and there can be embarrassment as a result of leaking urine whether that's from the smell or having to change or whatever. And it can be the financial issues, too, of having to buy more pads all the time. And so that can definitely be an issue for people who have this as an issue.

When should someone talk to their provider about urinary incontinence?

This can come on very slowly over time, can just become a little bit more frequent. Sometimes it just happens every once in a while, and it's not too bothersome. Once it becomes a very regular occurrence where it's happening multiple times a day, people are having to change clothes, having to change around a lot of their schedules in their life to accommodate that, that's definitely when they should see a provider to be able to try to figure out, "Okay, what's going on?"

Who is a good candidate for urinary incontinence surgery?

A good candidate for surgery is one who has a lot of issues in their daily life in being able to control their bladder. And especially if they've tried other things like pelvic floor physical therapy, which includes things like Kegels exercises strengthening the pelvic floor muscles to be able to contract and prevent leakage when you don't want that to happen.

How is urinary incontinence surgery performed?

So it is an outpatient procedure to get. It's a little tiny piece of mesh that goes right under the urethra to help replace the support structures that have been lost over time. I perform it in a transvaginal approach. So there is a little tiny incision that I make inside the vagina and use a special device called a trocar to be able to pass that right behind the pubic bone in front of the bladder to avoid any essential structures. And the sling to make it the right size so that it's not something that can be felt from the outside. And then sew up the tiny incision inside the vagina. Most people do not feel that particular incision.

What are typical recovery times following surgery?

Most people start feeling mostly back to themselves and not super sore within a week or two. It's not a whole lot for a recovery. Just like with any surgery, there is a little bit of tiredness that can be there still as your body recovers, but most people are feeling fairly well within that one to two-week period. It does require you to be doing no lifting over 10 pounds for a full six weeks. Reason being is we want that sling to set up and form good scar tissue and have good integrity before we start pushing and pulling on it which can loosen it and make it ineffective.

What are typical outcomes following surgery?

There are a lot of women that have complete cure of their urinary incontinence after having a sling procedure. Rates of satisfaction afterwards are somewhere, depending on the study that you look at, somewhere between 71% and 96% for this particular procedure. And so it can be a huge life change for a lot of women. You can have the physical improvements of having control of your bladder as well as the psychosocial part of it. Not feeling the need to, "Oh, I have to stay home instead of going out." And not feeling embarrassed around partners or family or friends. So that can be a huge impact in people's lives.

Why do you recommend surgery at Brookings Health System?

I would recommend someone come to Brookings Health System for this particular surgery, A) because I love taking care of my patients, and B) we do a great job from the beginning of getting you ready for surgery, during surgery, and after surgery in a local place to help you feel comfortable and confident through the entire surgical experience.