Treatment for Stress Incontinence Patient Decision Aid

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1 Treatment for Stress Incontinence Patient Decision Aid Patient Information Author ID: JD/NS Leaflet Number: Gyn 056 Version: 1 Name of Leaflet: Treatment for stress incontinence - Patient decision aid Date Produced: November 2014 Review Date: November 2016 Treatment for Stress Incontinence - Patient Decision Aid Page 1 of 6

2 What is stress incontinence? The muscles of the pelvic floor support the bladder and usually help keep it closed or open as necessary. Stress incontinence usually happens when these muscles become weak, so when there is sudden extra pressure stress on your bladder, it cannot stay closed as it should and some urine leaks out. This leakage happens during normal everyday activities, and most often when you cough, sneeze, laugh, exercise or change position. Whether you leak a small or large amount of urine, stress incontinence can be embarrassing and distressing. Stress incontinence can be triggered by pregnancy, childbirth or the menopause but sometimes there is no clear cause for it. Do I need treatment? What you do about stress incontinence will depend on how far it affects you and what you feel you can cope with as well as your general health. What treatments are available? Practical advice from a continence nurse specialist on managing your daily life such as: Adjusting your daily routines to help you cope better How you can help yourself by losing weight if you are overweight Managing a chronic cough if you have one Giving up smoking Physiotherapy Special physiotherapy exercises to make your pelvic floor muscles stronger and improve control of your bladder. These carry up to 70% chance of improving, or curing symptoms. It is usually recommended that a programme of physiotherapy be undertaken prior to considering any surgery. Tablets A tablet called Duloxetine (Yentreve) can help stress incontinence for some people, though it only works for as long as you are taking it and does not suit everyone. Duloxetine (Yentreve ) was originally developed to treat depression. However, it was found to help with stress incontinence separately to its effect on depression. It is thought to work by interfering with certain chemicals that are used in transmitting nerve impulses to muscles. This helps the muscles around the urethra (the urethra is the tube through which urine flows out from the bladder) to contract more strongly and prevent leakage. The common side effects of this medication include feeling sick, sickness, indigestion, constipation, dry mouth and sleep disturbance as well as disturbed mood. These side Treatment for Stress Incontinence - Patient Decision Aid Page 2 of 6

3 effects are mostly when you start taking the tablets. Therefore you will be started on a low dose gradually increasing as follows: 20 mg nightly for 3 days then 20mg twice a day for 3 days then 20mg in the morning and 40mg at night for 3 days then 40mg twice daily (the full dose). Duloxetine should not be stopped suddenly as you may develop some troublesome symptoms like headache, nausea, paraesthesia (numbness), tremor, sleep disturbances, dizziness and anxiety. If you decide to stop taking the tablets you should reduce the dose gradually reversing the way in which you started it. Outpatient procedure Stress incontinence can be treated by an outpatient procedure avoiding the need for admission. Complications are rare but success rates are slightly lower than for surgery. Bulkamid (urethral bulking agent) This is covered by a separate leaflet. Surgery Not everyone with stress incontinence needs an operation. Whether you choose to have surgery will depend on how far stress incontinence affects your daily life and what you feel you can cope with. You may want to consider surgical options if other things (such as exercises to help strengthen the muscles in the pelvic floor) have not helped. Surgical procedures for stress incontinence are not usually suitable if you still plan to have children, or think you might want to in the future. Before any surgical procedure you will be asked to attend for tests on your bladder (urodynamic studies) to confirm that the problem is stress incontinence and therefore likely to be helped by surgery. Surgical options available in Wigan and Leigh are: Vaginal tapes (TVT or TVT-O) Colposuspension Each of these options is covered by a separate leaflet. Treatment for Stress Incontinence - Patient Decision Aid Page 3 of 6

4 Patient decision aid Key facts Stress incontinence does not need to be treated if it does not inconvenience you You may be able to treat stress incontinence by doing pelvic floor exercises Medicines may help you control urine leaks, but they don't work for everyone and you need to keep on taking them Surgery works better than any other treatment for stress urinary incontinence in women BUT Sometimes surgery for stress incontinence causes new symptoms of urgency or urgency incontinence Sometimes symptoms come back Surgery has risks, including trouble passing urine after surgery, injury to the bladder or other pelvic organs, problems caused by the tape used in surgery Treatment for Stress Incontinence - Patient Decision Aid Page 4 of 6

5 Surgery A vaginal tape procedure takes 30 minutes and is a day case procedure. It can be done with local anaesthesia and sedation or general anaesthesia. Colposuspension takes one hour and requires a general anaesthetic. You will stay in the hospital for 2-3 days. Recovery can take 1 to 3 weeks (vaginal tape) or up to 6-8 weeks (colposuspension). What are my options? Don't have surgery You opt for no treatment Treatment for Stress Incontinence - Patient Decision Aid Page 5 of 6 You do pelvic floor muscles exercises to strengthen your pelvic muscles. You try medicines You have bulking injections to the urethra (tube through which you pass urine) which can be carried out in the outpatient clinic What are the benefits? After surgery you should have less Stronger muscles help control urine urine leakage or none at all when you leaks. do things that put pressure on your Pelvic floor muscle exercises cure bladder incontinence in many women who try them. You avoid the risks of surgery. What are the risks and side effects? Surgery doesn't always work. Symptoms may come back after surgery. Complications may not be reversible Risks depend on the type of surgery. Risks include: Trouble passing urine after surgery, New symptoms of urgency or urgency incontinence Injury to the bladder or other pelvic organs, and problems caused by the mesh tape used in surgery Internal bleeding, injury to an organ, infection (rare especially for tapes). Stitches that pull out, rejection of the tape, and problems with the tape eroding through the skin of the vagina, bladder or urethra (rare). All surgery has risks, such as bleeding, infection, thrombosis (blood clots in legs or lungs) and problems linked to anaesthesia. Your age, your weight and your general health can also affect your risk. These treatments don't work for everyone. You may still need to have surgery. Medicines for stress incontinence have side effects such as nausea, dizziness, trouble sleeping, and a cough or sore throat. They can however always be stopped and these effects reversed

6 Comments, Compliments or Complaints The Patient Relations/PALS Department provides confidential on the spot advice, information and support to patients, relatives, friends and carers. Contact Us Tel: (Monday to Friday 9am to 4pm) The Patient Relations/PALS Manager Wrightington, Wigan and Leigh NHS Foundation Trust Royal Albert Edward Infirmary Wigan Lane Wigan WN1 2NN In addition to the Patient Relations/PALS Service, you can contact HELPline on This leaflet is also available in audio, large print, Braille and other languages upon request. For more information call Wrightington, Wigan and Leigh NHS Foundation Trust All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner Treatment for Stress Incontinence - Patient Decision Aid Page 6 of 6

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