Dramatic improvement in symptoms with surgery
A new study has found that, contrary to current thinking, surgery for mixed urinary incontinence (stress + urgency) improves symptoms of both types of incontinence dramatically, although further improvement is found with surgery together with behavioural and pelvic floor muscle therapy.
Article
Surgery for stress urinary incontinence (leaking that occurs with a cough or sneeze) improves symptoms of another form of incontinence, called urgency urinary incontinence, in women who have both types, according to a study supported by the National Institutes of Health. The findings challenge current treatment guidelines, which suggest that the surgery may worsen urgency urinary incontinence in women with both forms, also called mixed urinary incontinence. The study appears in the Journal of the American Medical Association. Funding was provided by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and Office of Research on Women’s Health.
“Women with mixed urinary incontinence may have more bothersome symptoms than women with either stress or urgency urinary incontinence alone,” said Donna Mazloomdoost, M.D., study author and program director of the NICHD Pelvic Floor Disorders Network. “The findings show promise in treating a condition that can be hard to manage under existing practices.”
Roughly one-third to one-half of all women with urinary incontinence have mixed urinary incontinence. Urgency urinary incontinence results from the spontaneous contraction of bladder muscles, leading to a strong and sudden need to urinate. Stress urinary incontinence occurs when urine leaks out after abdominal pressure increases following a sneeze, cough, laugh or movement, which squeezes the bladder.
Standard treatment guidelines for mixed urinary incontinence often involve treating the two forms of incontinence independently. Urgency urinary incontinence often is first treated with behavioral techniques, such as trying to delay urinating for a brief period after feeling the urge, reducing liquid consumption, exercises to strengthen muscles around the bladder (involving pelvic floor physical therapy) and with medication. Surgery is not usually recommended early on. Stress incontinence also can be treated with exercises, and many women experience symptom improvement. However, in women who do not improve or opt out of the exercises, surgery may be offered.
The combined surgery and physical therapy group had fewer instances of incontinence a year after surgery and were less likely to receive additional treatment for urinary tract symptoms, suggesting they had more quality of life improvement than the surgery alone group.
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SOURCE: National Institutes of Health News Releases
Surgery may benefit women with two types of urinary incontinence
Tuesday, September 17, 2019
Reference: Journal of the American Medical Association DOI: 10.1001/jama.2019.12467 (2019)
Effect of behavioral and pelvic floor muscle therapy combined with surgery vs. surgery alone on incontinence symptoms among women with mixed urinary incontinence: the ESTEEM randomized clinical trial.
Sung VW et al.,