Continence Coach: Tackling Stress Urinary Incontinence: The Resourceful Continence Nurse
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Other behavioral intervention includes encouraging loss of excess weight. Research by the University of California-San Francisco (UCSF) and others4 has demonstrated that women who lost just 10% of their body weight reduced their leakage from SUI by half and maintained these results for 6 months. Smoking cessation also is recommended as a first-line approach to reduce or eliminate SUI episodes because the chronic cough associated with smoking tobacco causes recurrent, downward pressure on the bladder.
Topical estrogen, not to be confused with hormone replacement therapy in considerably higher doses, has been shown helpful in older women, particularly in persons with post-menopausal vaginal dryness and/or atrophy.
Another technique to treat SUI is involves injecting agents to bulk up the tissues around the urethra. The goal of injection therapy is close the sphincter without obstructing it. The best results from injection therapy occur when the leakage is a result of ISD but pelvic muscle support remains good. Many research studies have shown that up to 80% of women become “dry” or improved after three treatment sessions; however, this approach is not considered a permanent solution because the body absorbs the agent over time.5
A newer, nonsurgical approach uses radiofrequency (RF) energy to “remodel” and subsequently thicken the supportive tissue to recreate the natural hammock’s strength. The procedure is performed in an office setting without incisions or sutures and is considered free of adverse events and thus safe.6 After 3 years of follow-up, half of the RF patients demonstrated a 50% or greater reduction in frequency of urine leakage.7
Multiple strategies are available for tackling SUI, especially in women. A continence nurse needs to know the full extent of her resources and keep patients engaged and hopeful.
1. Albo ME, Richter HE, Brubaker L, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. New Engl J Med. 2007;356(21):2143–2155.
2. Ouslander J, Staskin D, Raz S, Su HL, Hepps K. Clinical versus urodynamic diagnosis in an incontinent geriatric female population. J Urol. 1987;137(1):68–71.
3. Wells TJ, Brink CA, Diokno AC, Wolfe R, Gillis GL. Pelvic muscle exercise for stress urinary incontinence in elderly women. J Am Geriatr Soc. 1991;39(8):785–791.
4. Subak LL, Wing R, West DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. New Engl J Med. 2009;360(5):481–490.
5. Rackley R, Ingber MS, Faroozi F. Injectible bulking agents for incontinence. Available at: http://emedicine.medscape.com/article/447068. Accessed September 24, 2010.
6. Dillon B, Dmochowski MD. Radiofrequency for the treatment of stress urinary incontinence in women. Curr Urol Rep. 2009;10(5):369–374.
7. Appell RA, Singh G, Klimberg IW, et al. Nonsurgical radiofrequncy collagen denaturation for stress urinary incontinence: retrospective 3-year evaluation. Exp Rev Med Devices. 2007;4(4):455– 461.
The National Association For Continence is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence. This article was not subject to the Ostomy Wound Management peer-review process.