Treatment for stress urinary incontinence

Urinary incontinence is not a normal part of ageing, nor the price of childbirth. It is a symptom that has its own type and its own treatment. Every decision, including one about treatment, starts with identifying the type.

Who carries it out

gynaecologist

Length of the procedure

30 to 60 minutes

Series

1 to 3 treatments, monthly

Anaesthesia

local

Consultation

150 PLN, free follow-up

Symptoms of stress urinary incontinence

Urine leaks involuntarily at the moment of increased pressure in the abdominal cavity: during coughing, sneezing, laughing, lifting a weight, or while running and jumping. The symptom is not linked to a feeling of urgency; it appears when the body is making an effort.

The condition changes everyday functioning: it limits physical activity, forces you to plan your day around toilet access, and affects wellbeing. These are reasons to treat it, regardless of age.

Identifying the type first, then the method

Urinary incontinence has several forms, and each is treated differently:

• Stress: urine leaks during physical effort, without urgency. The treatment described on this page addresses this form.
• Urge: a sudden, hard to control need to urinate. Treatment follows a different path, often pharmacological. Fractional treatment is not a method here.
• Mixed: both forms at once. The approach depends on which component predominates.

That is why the first visit is about diagnosis: a medical history, a gynaecological examination, sometimes a bladder diary or a urine test. Some patients are referred first to a urogynaecologist or to pelvic floor physiotherapy, and this is not delaying the problem, only the correct order.

The following require urgent diagnosis: blood in the urine, pain when passing urine, recurrent urinary tract infections, sudden onset of symptoms, and a feeling of bulging in the vagina, which may indicate pelvic organ prolapse.

Causes of stress urinary incontinence

The primary cause is weakening of the pelvic floor muscles, which under normal conditions surround the urethra and allow it to close during physical effort. The second is stretching of the vagina, for example after childbirth, which changes the angle of the urethra.

• vaginal births, especially multiple or complicated ones,
• hormonal changes during menopause and the associated mucosal atrophy,
• overweight and obesity, which increase pressure in the abdominal cavity,
• chronic cough and work involving heavy lifting,
• age related weakening of connective tissue.

The frequency of this condition increases with age and after childbirth, but it also affects young women, including athletes. This is not a problem of age, but a problem of structure and function.

The basis of treatment: pelvic floor muscles

Pelvic floor muscle training, known as Kegel exercises, is the first step in stress urinary incontinence. Effectiveness depends on regularity and correct technique, so it is worth learning it from a urogynaecological physiotherapist, not from a video online. Incorrectly performed exercises can worsen muscle tension.

Fractional treatment does not replace this training. It can be a complement to it, especially when exercise alone is not enough.

What the research says: pelvic floor muscle training is recognised as the first choice treatment for stress urinary incontinence. Studies on intravaginal radiofrequency are few and conducted on small groups. In a double blind controlled trial, adding radiofrequency to training brought additional improvement in women with a moderate form, and the authors noted that further studies are needed for the severe form. In a three arm trial, improvement was achieved both after radiofrequency and after training alone, and radiofrequency produced the greatest difference in vaginal dryness. More recent papers state directly that evidence is still lacking.

Hence our position: we offer the treatment as a complement to an approach with stronger evidence, and we do not promise a specific outcome.

What the fractional treatment looks like

The doctor inserts a fractional tip into the vagina. The energy delivered increases wall tension and stimulates the tissue to rebuild collagen fibres, which is intended to improve support for the urethra. Parameters are selected to limit heating of neighbouring tissue.

The treatment takes 30 to 60 minutes, under local anaesthesia. Usually one to three treatments are planned at monthly intervals; the number is determined by the doctor after the first session. Before the treatment, we recommend a cytology result no older than one year.

Immediately after the treatment, slight redness and swelling may appear, which usually subside within two days. Recovery time is not needed, but it is convenient to plan one quiet day.

Treatment results and what we do not promise

Change builds up gradually and is assessed about a month after the treatment, as that is how long tissue remodelling takes. The goal is to reduce the number and severity of episodes of urine leakage during physical effort.

• Effectiveness depends on the type and degree of severity. For severe forms, surgical treatment can be the method of choice, and we say so directly in that case.
• Not every patient achieves full control over urination. Some achieve partial improvement.
• The effect does not last forever. Tissue continues to change, and after some time a repeat treatment may be needed.
• The treatment does not treat urge urinary incontinence or pelvic organ prolapse.

Recommendations after the treatment: for a week, no intercourse, no sauna or hot baths, with limited physical exertion. Contraindications are the same as for vaginal rejuvenation: pregnancy, menstruation, active intimate infection, cancer, and bleeding of undetermined cause until diagnosis is complete.