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Specialists at St. Charles's Hospital's Female Urinary Incontinence and Pelvic Floor Center provide the spectrum of surgical and nonsurgical treatments. Women with mild-to-moderate symp- toms often elect to tr y conser vative options, which include biofeedback, electrical bladder stimulation, pessary use and medications, such as local- ized estrogen-replacement cream or muscarinic receptor antagonists. Pessaries are small devices, similar to a diaphragm, that are inserted vaginally to support a prolapsed vagina, uterus, bladder or rectum and to help address pelv ic pa in, pressure a nd ur ina r y incontinence. According to Dr. Press, however, pessa ries may not be the most attractive option for younger, active women because they can cause side effects, such as vaginal discharge or irritation, and need to be changed monthly by a physician. Biofeedback is a technique used to retrain the pubococcygeus muscle and may be useful for women with pelvic organ prolapse and/or stress inconti- nence. Biofeedback is performed by either placing an electronic device into the vagina or by placing electrodes near the anus and on the abdomen to mea- sure movement of the pubococcygeus muscle. Women are asked to perform Kegel exercises, and the biofeedback device displays muscle movement on a computerized graph. When the pubo- coccygeus muscle is activated correctly, women receive positive feedback to let them know they are performing Kegel exercises properly. The typical course of biofeedback treatment consists of four 30-minute sessions. According to Dr. Press, biofeedback is effective for mild stress and urge incontinence due to prolapse but isn't useful for treatment of severe symptoms. "The goal of biofeedback therapy is to teach women how to do these exercises correctly so they can perform them on their own," Dr. Press says. "The concept behind Kegel exercises is the same concept as lifting weights. If you stop lifting weights, muscles atrophy, so women must continue performing these exercises daily to continue seeing results." L i ke biofe e dback , u se of a n elect r ica l st imula- tor for bladder control is indicated for people with mild incontinence. During e l e c t r i c a l s t i m u l a t i o n , however, patients are not required to perform Kegel exercises. Rather, the pelvic floor muscles are stimulated directly by electrodes on the patient's abdomen that emit electrical pulses, stimulating contraction of the leva- tor ani muscle and urinary sphincter. According to Dr. Press, elect r ica l bladder stimulation can be used as a primary therapy or in conjunction with biofeedback. The final conser vative option for managing stress and urge incontinence involves use of loca lized estrogen- repla cement c re a m. T h i s topic a l medication helps restore muscle tone in the atrophied urethra. Because it is a localized rather than systemic therapy, the potential side effects associated with hormone-replacement therapy are avoided. If these conservative measures fail, surgery may be the right choice. "Most women choose to have surgery for stress incontinence when they reach the point where they can't perform regu- lar activities," Dr. Press says. "These women can't ride a bike or go to the gym and are using two to three pads a day due to leakage. When women decide they are finished having children, it's usually time to proceed with surgery." However, surgery for stress incon- tinence is contraindicated for women who plan on having more children because the mesh sling inserted during a vaginal sling procedure, which is used to hold the urethra in place, can cause urethral damage during pregnancy and childbirth. The 7-Minute Sling Several years ago, controversy erupted regarding the use of mesh slings when the FDA released a warning regard- ing mesh-related complications. It is Dr. Press reviews the results of a urodynamic test performed at his Port Jefferson office. Vaginal slings vary in size. The sling shown here is slightly larger than a quarter. COV ER FE AT UR E 8 | Long Island MD NEWS ■ M D N E W S . CO M