Stress Urinary Incontinence: Guiding Patients from Symptoms through Treatment
A recent JAMA review study found that approximately half of adult women may experience stress urinary incontinence (SUI), but few of them get diagnosed and treated despite a wide range of options to address the problem: Only about one in four women with urinary incontinence seek care, and then fewer than half of them receive treatment.1
“There are several barriers – the most important thing being women are embarrassed so they cope and don’t say anything,” senior author Dr. Linda Brubaker of the University of California, San Diego, told Reuters.2 “They should be honest with themselves–once these symptoms are interrupting their lives and they won’t go for a walk or run or they avoid intimacy because of this, they should seek care. The earlier they connect (with a clinician), the easier the treatment is and the higher the chance of success.”
Delaying Care for SUI: A Closer Look
- Women may delay seeking care for years
- Many women lack knowledge of the condition and available treatment options unless they know someone who has shared their symptoms and experience
- They see SUI as normal rather than a treatable condition
- Many women are embarrassed to talk about SUI, including with their doctors
- They may be “too busy” with home or work, so they put off seeking help
Why Women Seek Care
- Symptoms worsen
- Have a significantly embarrassing episode
- Tired or frustrated with dealing with symptoms
- Partner or family affected
- Hate wearing or cost of pads
- Familiarity; know someone who had surgery
Why Women Delay Care
- Quality of life is not significantly impacted
- Accept it as normal part of motherhood/aging
- Unaware of treatment options
- Too busy with work and/or kids
- Put self last
- Mother has SUI and does not seek treatment
The research also identified patients’ path toward a sling procedure:
1. Symptoms – She experiences leakage, feels embarrassed, worried, concerned; quality of life decreases. May dismiss symptoms as a result of childbirth and/or part of aging and delay treatment.
2. Help-Seeking – She has enough concern and discomfort to seek help from family, friends and available online resources.
3. Diagnosis and Work-up – She either makes an appointment specifically to discuss symptoms OR discusses them with PCP or GYN during a routine office visit.
4. Conservative Management – She manages symptoms and copes with discomfort, lower quality of life. She works with her GYN, or URO GYN, and may try different types of solutions or mitigating actions, including wearing liners or pads, increasing bathroom frequency, or trying Kegel exercises, physical therapy or biofeedback.
5. Surgical Treatment – She finally is frustrated by her declining quality of life, discomfort and inconvenience. Often as a last resort, she decides to have surgery, which can be sling or mesh, bladder suspension, hysterectomy plus sling or injections.
Helping Patients Along the Treatment Journey
As providers, how can you help encourage surgical treatment, where appropriate, to get patients from frustration to relief?
According to Dr. Anne Suskind, a urology researcher at the University of California, San Francisco, who wasn’t involved in the JAMA study or Boston Scientific research, doctors may need to start the discussion because women may be embarrassed. “It is so important for physicians to ask patients about urinary incontinence, when appropriate, in order to open a dialogue and to help women who may benefit from treatment,” Dr. Suskind told Reuters.
The Boston Scientific research echoes this point. While websites and friends or loved ones were important resources for women seeking treatment, they said their physician had the greatest impact on their decision to have surgery. Many women report that the main drivers for having surgery are their doctor’s recommendation and a high level of trust in him or her. Some reported that they did or would go online and ask around to verify the doctor’s reputation.
The research identified specific steps physicians can take to help patients along their SUI journey:
- Screen for SUI. Bring up the topic so they feel comfortable to talk about it. Let them know that, although it is common, it is not a normal part of aging. Provide patients with a checklist or ask questions during the exam.
- Listen and provide reassurance. Have good bedside manner—listen and communicate well. Patients need to feel that they can trust you.
- Ask about and address specific barriers to treatment. Knowledge, time, embarrassment, fear, recovery, etc., can all impact the decision-making process. Provide answers and reassurance.
- Provide patient information on treatment options. Guide patients through the remedy of symptoms. List out the options and make a clear recommendation. Answer all her questions. Let her know that there is a continuum of treatment options available, so if conservative management does not provide long-term symptom relief, there are surgical options that may.
- Explain procedure in detail. Go step by step—from planning to recovery phase—using charts, models and posters. Also discuss your experience, including number of procedures and any potential questions regarding the safety of the devices.
- Provide resources. Offer handouts or websites that include testimonials from other women who have had the procedure. Also consider group sessions to educate patients and allow peer-to-peer interaction.
By initiating the conversation about SUI and treatment options with your patients, you have an opportunity to help patients find relief—like JW, a research study participant whose SUI journey is similar to that of so many women:
“The doctor was exceptional, he was so calming. He used a video and a model. After having it, I am a new person … it literally changed my life. I am mad at myself for waiting. I did not sit and think and seek out advice.”