Urinary incontinence – the loss of bladder control – is a common problem among women, affecting up to 15% of women in this country. The two most common types are urge incontinence – often referred to as an overactive bladder – and stress urinary incontinence or SUI. SUI is the loss of small amounts of urine associated with coughing, laughing sneezing, exercising or other movements that increase intra-abdominal pressure and thus increase pressure on the bladder.

Why does SUI occur? The muscles and tissues of the pelvic floor support the bladder and the urethra, the tube that connects the bladder to the outside world. Pregnancy and childbirth can cause a stretching and weakening of these muscles/tissues. If this support is then insufficient, increased intra-abdominal pressure can result in leakage of urine. This condition can be treated in a variety of ways including pelvic floor exercises and bladder/urethral support surgery.

 

Shift gears for a minute and consider a tummy tuck. It’s a cosmetic surgical procedure performed to remove excess abdominal skin and fat as well as to tighten loose abdominal muscles. Patients often undergo a tummy tuck following pregnancy or after significant weight loss.

Just as there is a stretching of the abdominal muscles and skin with pregnancy, there may be a stretching of the pelvic floor muscles that support the bladder and urethra. As it turns out, if you tighten the abdominal muscles and skin, you may also increase the support of the bladder and urethra, improving urinary incontinence!! 

A recent paper (Aesthetic Surgery Journal 2014; 34:1091-1098) gives further details. As discussed in the article, a group of women who underwent tummy tucks and who had symptoms of SUI before surgery were questioned as to improvement of their symptoms after surgery. 60% of these patients noted improvement in their incontinence. Interestingly it was those patients who had not undergone a cesarean section before who were most likely to improve.

What was it about a tummy tuck that led to the decrease in incontinence? The authors believe that it was both the skin and abdominal muscle tightening that led to the improvement in symptoms, depending on the particular case of SUI. In that some tummy tucks do not necessarily involve a muscle tightening, the authors suggest that urologic testing of women with SUI before tummy tuck surgery may allow for a customization of the tummy tuck, depending on the specifics of the case of SUI. They also make the excellent suggestion that if a woman is a candidate for a tummy tuck and also has SUI, that she undergoes the tummy tuck first. There may be enough improvement in the SUI from the tummy tuck alone to allow her to forego the procedure for treatment of the SUI.

Your thoughts?

George Sanders, M.D.