As women age, urinary incontinence becomes more common. For some women, laughing, coughing, sneezing or exercising can cause an embarrassing leakage known as stress incontinence. When conservative measures don’t help, surgery may be an option for stress incontinence.
A “sling” uses a woman’s own tissue or synthetic mesh to create a hammock around the bladder neck and the tube that carries urine from the bladder (urethra).
Listen in as Nelson C. Echebiri, MD explains how the sling works and how it can offer relief to so many women.
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Surgical Sling Placement To Fix Stress Incontinence
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Learn more about Nelson C. Echebiri
Nelson C. Echebiri, MD
Nelson C. Echebiri, M.D., M.B.A. earned his medical degree from the University of Kentucky College of Medicine in Lexington, Ky., and completed his residency at the University of Buffalo, New York. Dr. Echebiri is board eligible in obstetrics and gynecology with the American Board of Obstetrics and Gynecology. His special interest is in high risk pregnancy and minimally invasive gynecologic surgery.Learn more about Nelson C. Echebiri
Transcription:
Surgical Sling Placement To Fix Stress Incontinence
Melanie Cole (Host): As women age, urinary incontinence becomes more common. For some women, laughing, coughing, or sneezing or exercising can cause an embarrassing leakage known as stress incontinence. My guest today is Dr. Nelson Echebiri. He's an obstetrician/gynecologist with Meritus Women's Health Specialists Robinwood. Welcome to the show, doctor. So, let's speak about incontinence. Women are sometimes hesitant to discuss this with friends or their doctors because it's a little bit embarrassing. What do you want women to know about bringing this up with their doctors and the importance of seeking treatment if it's affecting their quality of life?
Dr. Nelson Echebiri (Guest): Thank you for inviting me. I mean, one of the reasons why we selected this topic is sadly what you said. A lot of women have problems with urinary incontinence. Millions of women worldwide have this problem. You have about 25% of young women and then 75% of older women experience some kind of involuntary urine loss. I call this “the sisterhood of silence”, just like you mentioned. For some reason, women are very reluctant to talk about this problem even though millions of women are affected. I think it's because women, in general, are embarrassed to bring this topic up and sometimes, as physicians, we may be reluctant to even discuss these issues with women. So, I think, in general, now that we know that this is very, very common, it's probably a good idea for we, as physicians, to endeavor to bring this issue up any time we encounter women; either during their yearly exams, or any time women present to our office with any kind of complaint.
Melanie: So, what are some of the different types of urinary incontinence?
Dr. Echebiri: So, the different types of urinary incontinence. The main two divisions are what we call “stress incontinence” and then we have what we call the “urgent incontinence”. Now when we say stress, this is not like emotional stress. When I say stress, I mean like when you're coughing, women picking up their grandkids, you know, sneezing, those kinds of pressure, intra-abdominal pressure that increases pressure on the bladder, and then you leak urine. And then, the urgent incontinence the one that's, you have this compelling desire to urinate. You know, you just want to use the bathroom, but you can't get there. On your way to use the bathroom, you just leak urine. So, those are the main two types: stress and urgent incontinence.
Melanie: So, how does someone know which kind they have and who do they go to to seek treatment?
Dr. Echebiri: Well, you can definitely talk to your primary care doctor and then your primary care doctor can definitely refer you to an OB/GYN with specialty in treatment, surgical treatment, for stress incontinence or pharmacological treatment for urgent incontinence. And, you can also definitely see a urologist, but women sometimes prefer to see the OB/GYN, and we can definitely take care of any of these problems. Now, you ask, “How do you tell the difference?” I mean, women can always tell if they're leaking when they cough or sneeze, or they can also tell when they have the urges to urinate and then when they go, or when they're about to go to the bathroom, they just leak urine. Then you have those, you know, from their clinical presentation, they can tell what is going on. Even if it's a little bit confusing, when they come to the office, we have a questionnaire that we can use to help guide as they think about what is actually going on at home.
Melanie: When do they decide to seek treatment?
Dr. Echebiri: So, when do they decide? I think that's an important question because when I see women with similar problems, the first thing I ask is "Is it bothering you?" If you're leaking urine and it's just a very small amount and it's not bothering you, then there's really no reason for any surgical intervention. So, when they, they should seek treatment if it's getting to the point that it is affecting their quality of life, you know? So they have various treatments, safe treatments out there that can help with their situation. So, once you get to the point whereby you know, you can't handle the situation anymore and it's just affecting your quality of life, basically, she definitely should seek help.
Melanie: So, then let's speak about some of the treatments available. What would be the first line of defense if you met a woman and she's got these issues and it is affecting her quality of life, what do you do for her right at the beginning?
Dr. Echebiri: Well, in terms of approaching urinary incontinence, first of all, we want to make sure that there's no infection. So we can do what we call a urinalysis, just to rule out an infection because sometimes infection can cause incontinence. Then, we try to figure out which one it is. Is it stress or is it urgent incontinence? Any of those you can actually do what are called lifestyle modifications. I mean, if you drink so much caffeine, or if you drink a lot of fluid before you go to bed, or any of those lifestyle modifications we can try to see if that rectifies the problem. And then, you know, stress incontinence, one of the main treatments for stress incontinence is the surgical approach. We have the minimally-invasive approach. We don't have to open the belly; we don't have to do any of those things--we can just put what we call a “mid-urethral sling” through the vagina and that helps to hold the urethra up so that you don't have any more leakage of urine when you cough or sneeze. So, this is a minimally-invasive approach that can be done to rectify the problem. And then, when it comes to urge, there is a medication that can be used for urgent incontinence.
Melanie: So, speak about the slings, then, for a minute. You said it's minimally-invasive. Is this a permanent situation once you've put that in? Does it stay there and what does it feel like for a woman?
Dr. Echebiri: So, the sling is permanent. It's propylene mesh. You know, there's always these shows on TV about the mesh, problems with the mesh, but that mesh is totally different. This is not the type of mesh we use for like prolapse. This is a very small mesh and it's put in the vagina underneath the urethra and women may not . . . It's an ambulatory surgery, so it gets done and you go home the same day. So, you may not even notice there is something there. The only thing that you notice is that you no longer leak urine when you cough or sneeze you know, if the treatment is effective. In terms of you feeling that it’s even necessarily there, you wouldn't even know there was anything there after surgery because it’s just a very small sling that is placed under the urethra. So, in terms of clinical symptoms, you will notice there's a difference in terms of you will no longer leak urine when you cough or sneeze.
Melanie: And, does this mesh dissolve? Does it stay in there permanently? Will it ever have to be redone?
Dr. Echebiri: Correct. It stays there permanently. Can it be redone? Yes, because sometimes you may have to put another mesh. Let's say you put in the first mesh and then there's a failure. You may have to try a different approach to resolve the problem if the problem is still stress incontinence. So, your question is a good question. Sometimes you may end up with two surgeries to fix the same problem but ,in general, one mesh is always enough and it stays there permanently.
Melanie: And, you spoke about some lifestyle modifications. Give us some of your best tips for more of those modifications besides caffeine, not drinking too much at bedtime. Are there some exercises? Does Kegel exercise help with incontinence? Give us some more lifestyle.
Dr. Echebiri: Correct. Kegel exercise, any kind of pelvic floor exercise can help, and then when you talk about smoking, stopping smoking can always help. Most research has shown if you stop smoking, that can sometimes help with stress incontinence. But, those are probably the biggest ones--pelvic floor exercise--and if you smoke a lot, then if you can minimize the amount of cigarettes. That can actually help.
Melanie: So, then wrap it up for us, give your best advice to women who are suffering from incontinence, what you tell them every single day, doctor, and why they should come to Meritus Women's Health Specialists for their care?
Dr. Echebiri: So, definitely what I would say is millions of women are having this problem. There is no reason for you not to seek help if it is bothering you, okay? So, it's something that Meritus Women's Health Specialists can take care of, especially using the minimally-invasive operation to put a sling underneath the urethra. Many of the symptoms of stress, you know, you pick up your baby, or your grandkids, or you cough during the allergy season, then, you know, and you're sneezing, then you're having urine leakage, then you definitely want to come in and talk to us. If you don't have any referral to us, you can talk to you PCP and they can definitely refer you to come see us. So, there's no reason for anyone that has incontinence for their lifestyle affected while not seeking help. That would be what I would say.
Melanie: Thank you so much for being with us today, doctor, it's great information. You're listening to Your Health Matters with Meritus Health and for more information, you can go to www.meritushealth.com. That's www.meritushealth.com. This is Melanie Cole. Thanks so much for listening.
Surgical Sling Placement To Fix Stress Incontinence
Melanie Cole (Host): As women age, urinary incontinence becomes more common. For some women, laughing, coughing, or sneezing or exercising can cause an embarrassing leakage known as stress incontinence. My guest today is Dr. Nelson Echebiri. He's an obstetrician/gynecologist with Meritus Women's Health Specialists Robinwood. Welcome to the show, doctor. So, let's speak about incontinence. Women are sometimes hesitant to discuss this with friends or their doctors because it's a little bit embarrassing. What do you want women to know about bringing this up with their doctors and the importance of seeking treatment if it's affecting their quality of life?
Dr. Nelson Echebiri (Guest): Thank you for inviting me. I mean, one of the reasons why we selected this topic is sadly what you said. A lot of women have problems with urinary incontinence. Millions of women worldwide have this problem. You have about 25% of young women and then 75% of older women experience some kind of involuntary urine loss. I call this “the sisterhood of silence”, just like you mentioned. For some reason, women are very reluctant to talk about this problem even though millions of women are affected. I think it's because women, in general, are embarrassed to bring this topic up and sometimes, as physicians, we may be reluctant to even discuss these issues with women. So, I think, in general, now that we know that this is very, very common, it's probably a good idea for we, as physicians, to endeavor to bring this issue up any time we encounter women; either during their yearly exams, or any time women present to our office with any kind of complaint.
Melanie: So, what are some of the different types of urinary incontinence?
Dr. Echebiri: So, the different types of urinary incontinence. The main two divisions are what we call “stress incontinence” and then we have what we call the “urgent incontinence”. Now when we say stress, this is not like emotional stress. When I say stress, I mean like when you're coughing, women picking up their grandkids, you know, sneezing, those kinds of pressure, intra-abdominal pressure that increases pressure on the bladder, and then you leak urine. And then, the urgent incontinence the one that's, you have this compelling desire to urinate. You know, you just want to use the bathroom, but you can't get there. On your way to use the bathroom, you just leak urine. So, those are the main two types: stress and urgent incontinence.
Melanie: So, how does someone know which kind they have and who do they go to to seek treatment?
Dr. Echebiri: Well, you can definitely talk to your primary care doctor and then your primary care doctor can definitely refer you to an OB/GYN with specialty in treatment, surgical treatment, for stress incontinence or pharmacological treatment for urgent incontinence. And, you can also definitely see a urologist, but women sometimes prefer to see the OB/GYN, and we can definitely take care of any of these problems. Now, you ask, “How do you tell the difference?” I mean, women can always tell if they're leaking when they cough or sneeze, or they can also tell when they have the urges to urinate and then when they go, or when they're about to go to the bathroom, they just leak urine. Then you have those, you know, from their clinical presentation, they can tell what is going on. Even if it's a little bit confusing, when they come to the office, we have a questionnaire that we can use to help guide as they think about what is actually going on at home.
Melanie: When do they decide to seek treatment?
Dr. Echebiri: So, when do they decide? I think that's an important question because when I see women with similar problems, the first thing I ask is "Is it bothering you?" If you're leaking urine and it's just a very small amount and it's not bothering you, then there's really no reason for any surgical intervention. So, when they, they should seek treatment if it's getting to the point that it is affecting their quality of life, you know? So they have various treatments, safe treatments out there that can help with their situation. So, once you get to the point whereby you know, you can't handle the situation anymore and it's just affecting your quality of life, basically, she definitely should seek help.
Melanie: So, then let's speak about some of the treatments available. What would be the first line of defense if you met a woman and she's got these issues and it is affecting her quality of life, what do you do for her right at the beginning?
Dr. Echebiri: Well, in terms of approaching urinary incontinence, first of all, we want to make sure that there's no infection. So we can do what we call a urinalysis, just to rule out an infection because sometimes infection can cause incontinence. Then, we try to figure out which one it is. Is it stress or is it urgent incontinence? Any of those you can actually do what are called lifestyle modifications. I mean, if you drink so much caffeine, or if you drink a lot of fluid before you go to bed, or any of those lifestyle modifications we can try to see if that rectifies the problem. And then, you know, stress incontinence, one of the main treatments for stress incontinence is the surgical approach. We have the minimally-invasive approach. We don't have to open the belly; we don't have to do any of those things--we can just put what we call a “mid-urethral sling” through the vagina and that helps to hold the urethra up so that you don't have any more leakage of urine when you cough or sneeze. So, this is a minimally-invasive approach that can be done to rectify the problem. And then, when it comes to urge, there is a medication that can be used for urgent incontinence.
Melanie: So, speak about the slings, then, for a minute. You said it's minimally-invasive. Is this a permanent situation once you've put that in? Does it stay there and what does it feel like for a woman?
Dr. Echebiri: So, the sling is permanent. It's propylene mesh. You know, there's always these shows on TV about the mesh, problems with the mesh, but that mesh is totally different. This is not the type of mesh we use for like prolapse. This is a very small mesh and it's put in the vagina underneath the urethra and women may not . . . It's an ambulatory surgery, so it gets done and you go home the same day. So, you may not even notice there is something there. The only thing that you notice is that you no longer leak urine when you cough or sneeze you know, if the treatment is effective. In terms of you feeling that it’s even necessarily there, you wouldn't even know there was anything there after surgery because it’s just a very small sling that is placed under the urethra. So, in terms of clinical symptoms, you will notice there's a difference in terms of you will no longer leak urine when you cough or sneeze.
Melanie: And, does this mesh dissolve? Does it stay in there permanently? Will it ever have to be redone?
Dr. Echebiri: Correct. It stays there permanently. Can it be redone? Yes, because sometimes you may have to put another mesh. Let's say you put in the first mesh and then there's a failure. You may have to try a different approach to resolve the problem if the problem is still stress incontinence. So, your question is a good question. Sometimes you may end up with two surgeries to fix the same problem but ,in general, one mesh is always enough and it stays there permanently.
Melanie: And, you spoke about some lifestyle modifications. Give us some of your best tips for more of those modifications besides caffeine, not drinking too much at bedtime. Are there some exercises? Does Kegel exercise help with incontinence? Give us some more lifestyle.
Dr. Echebiri: Correct. Kegel exercise, any kind of pelvic floor exercise can help, and then when you talk about smoking, stopping smoking can always help. Most research has shown if you stop smoking, that can sometimes help with stress incontinence. But, those are probably the biggest ones--pelvic floor exercise--and if you smoke a lot, then if you can minimize the amount of cigarettes. That can actually help.
Melanie: So, then wrap it up for us, give your best advice to women who are suffering from incontinence, what you tell them every single day, doctor, and why they should come to Meritus Women's Health Specialists for their care?
Dr. Echebiri: So, definitely what I would say is millions of women are having this problem. There is no reason for you not to seek help if it is bothering you, okay? So, it's something that Meritus Women's Health Specialists can take care of, especially using the minimally-invasive operation to put a sling underneath the urethra. Many of the symptoms of stress, you know, you pick up your baby, or your grandkids, or you cough during the allergy season, then, you know, and you're sneezing, then you're having urine leakage, then you definitely want to come in and talk to us. If you don't have any referral to us, you can talk to you PCP and they can definitely refer you to come see us. So, there's no reason for anyone that has incontinence for their lifestyle affected while not seeking help. That would be what I would say.
Melanie: Thank you so much for being with us today, doctor, it's great information. You're listening to Your Health Matters with Meritus Health and for more information, you can go to www.meritushealth.com. That's www.meritushealth.com. This is Melanie Cole. Thanks so much for listening.