It is estimated that more than 20 million American women have moderate or severe stress urinary incontinence. Despite the negative impact on quality of life, many patients are slow to complain and fail to seek medical care – a typical patient will suffer symptoms for more than 7 years before talking to a physician. For the elderly, problems of incontinence often weigh heavily towards institutional care.
There are many causes for stress urinary incontinence, and surgery is not always needed to resolve it.
Current practice guidelines clearly promote non-surgical
therapies first, and pelvic floor muscle exercises are often
effective, notably when combined with fluid regulation, diet,
and bowel management, because bladder control is always
better when the lower bowel is empty. Surgery should be
reserved for those who have failed these methods, and have
severe or moderate incontinence that can be demonstrated on
examination.
Pelvic support anatomy varies widely from patient to
patient: some pelvic floors are versatile and balanced; others
are asymmetrical and incomplete, causing problems of bladder
control, pelvic organ prolapse, and bowel dysfunction. Bladder,
bowel, and vaginal prolapse problems may occur in the
same patient, and other female family members are likely to be
similarly afflicted. Acquired diseases with a role in promoting
stress urinary incontinence include diabetes, lumbar or cervical
disc disease, and spinal stenosis, as well as a history of
pelvic floor insults such as vaginal delivery, hysterectomy, and
other pelvic surgery. Surgical procedures in the abdomen or
retroperitoneum may also disturb bladder function, and a
history of radiation therapy or peripheral neuropathy may
compromise surgical treatments.