I Think I Need a Sling

Doc, I think I need one of those bladder lifts.

I get this one a lot.  We see a lot of women in the office with bladder problems.  Quite frequently, they have a friend or relative that “had her bladder tied up” or “had a sling placed”, usually followed by “can I have that done?”.

This brings up a really interesting topic.  Incontinence is not incontinence is not incontinence.  What may have been a god-send for your great aunt Lorainne may not be the best way to manage your bladder issue. 

Incontinence is generally classified into two basic categories:  Urge Incontinence and Stress Incontinence.  The simple way to differentiate the two is by asking a few questions:  “Do you have trouble holding back the urge to urinate?  Does your leakage seem to happen most when you just can’t make it to the bathroom fast enough?” 

If you answered yes to those questions, you have an “urge predominance” to your incontinence.

Another set of questions: “Does your leakage seem to be associated with coughing, laughing, or sneezing?  What about walking, running, or jumping?  Do you wear a pad to bed and sometimes wake up wet?”

These questions are really meant to identify stress incontinence.

It’s really important for your doctor to get to the bottom of why you leak.  The treatments for these different types of incontinence are drastically different.  Urge incontinence can often be helped without surgery (although there are surgical options).  Stress incontinence can usually only be helped with a surgical procedure to reduce leakage. 

Be wary of the quick-fix surgery!  Incorrect treatment of one type of incontinence might actually make your bladder symptoms worse! 

Although we do see patients with either stress or urge incontinence, most of the time it is a “mixed” picture:  A little bit of both.  Sometimes additional testing might be required to determine what the best course of action might be.