Stress Incontinence

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Spring is here, the air is fresh and many of us are looking to get outside and get moving again!  However, many women suffer from stress urinary incontinence which often limits our desire to exercise.  In fact, it is estimated that nearly 70% of all women suffer from some type of urinary incontinence!  Stress incontinence is the unwanted loss of urine with an increase in intra-abdominal pressure.  For example, it is the loss of urine with laughing, coughing, sneezing, jumping, running or any activity that creates pressure on the abdomen, and therefore bladder.  Women with stress incontinence usually have decreased support of the urethra, or the tube that goes from the bladder to the outside, and this loss of support creates leakage.  Sometimes the leakage can be just drops and happen occasionally, maybe with a big sneeze, or during a long run outside.  Sometimes leakage can be more significant, and happen more often for women.  Regardless, if you are finding that you have incontinence, you should seek treatment based on the level of bother that it is giving you. If you are bothered, you should know there are options for treatment!

In most women, the treatment options for stress incontinence will be based on re-creating support for the urethra again.  Most conservatively, women can strengthen the pelvic muscles, also known as Kegel muscles, to create strong support around the urethra and decrease leakage.  Kegel muscle exercises can be done on your own at home, but often it is beneficial to meet with a specialized pelvic floor physical therapist to make sure you are targeting the correct muscles, and to get a specific exercise regimen to follow.  Kegel exercises are like any other exercise regimen – they work if you do them, and you need to keep up with them!  However, they are a low-risk option and have been shown to be successful in improving symptoms for women who pursue this option.

Another conservative way the urethra can be supported is with a supportive device that is placed in the vagina.  These can be disposable devices that are purchased at a local pharmacy, or reusable devices – called pessaries - that a specialist would provide to you after a consultation.  These devices are placed in the vagina to give more support to the urethra, and therefore decrease the leakage of urine.  The devices should be comfortable when they are in the vagina and can be inserted and removed easily, with minimal care and maintenance for the reusable pessaries.  In studies of women who use vaginal continence devices, approximately 50% reported satisfaction with this treatment option at one year.

Finally, a more permanent solution is surgery.  The most common and least invasive surgery for stress incontinence is often called a “sling.” A “sling” is a small piece of permanent material that is placed underneath the urethra by a specially trained surgeon through a small vaginal incision.  It is a same-day surgery with quick recovery and has been shown to be close to 90% successful in getting patients dry.  Of course, there are risks to any surgery, although in general, this type of surgery is relatively low risk.

It is important to know that you are not alone if you are suffering from urinary incontinence of any kind; there are treatment options available and you should feel comfortable speaking with your doctor.  They may suggest referral to a Urogynecologist or Pelvic Floor Specialist if they feel you would benefit from further expertise, or you can ask for this type of referral.  Most importantly, you should seek help so you feel comfortable getting out and getting active again!

B. Star Hampton, MD, is a Professor of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery at Warren Alpert Medical School of Brown University/Women & Infants Hospital. She is Chief Education Officer for Care New England Health System.


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