What is stress urinary incontinence?
Stress urinary incontinence is bladder leakage that occurs when a person coughs, laughs, sneezes, exercises or does anything that puts pressure or “stress” on the lower abdomen. Stress urinary incontinence affects 10-20% of women and can strongly impact a woman’s quality of life by influencing social or physical relationships, or even limiting general physical activity.
Stress urinary incontinence occurs when the muscles and ligaments that support the urethra become weakened and can be caused by pregnancy, childbirth, aging, chronic cough, chronic constipation, heavy lifting or straining, obesity or genetic factors.
When should I see a doctor?
You should get help if you have any of these symptoms:
- Bladder leakage or urinary incontinence
- Leaking with cough, laugh, sneeze or exercise
- Leaking with orgasm or sexual activity
- Limiting your physical activity to avoid leaking
- Feeling like you can’t empty your bladder well
- Bowel leakage or fecal incontinence
What are my treatment options?
The main treatments are pelvic floor exercises, pessaries, and surgery.
Pelvic muscle exercises/Kegel exercises:
Pelvic floor exercises or “Kegel exercises” as they’re commonly called, are squeezing of the pelvic floor muscles to try and strengthen them. In order for them to work they need to be done consistently and there are lots of resources online to help you get started! Women with stress urinary incontinence can get relief with these exercises.
If you need help performing these exercises, we can send you to a physical therapist who can help you target and strengthen your Kegel muscles.
Pessary:
Pessaries are vaginal devices (often silicone) that are placed inside the vagina and support the weakened urethra. Pessaries are also used for pelvic organ prolapse. They come in all shapes and sizes, and our nurse practitioner, Deb Carr, is an expert in fitting and managing pessaries. A pessary is a good choice for women who wish to delay or avoid surgery. Some women are able to insert and remove the pessary on their own, others cannot and we are able to change it for them in the office.
Surgery:
The aim of surgery is to correct weakness of the supports of the bladder neck and urethra. For women who desire surgery, we offer the full range of options for stress urinary incontinence and we treat each patient individually.
For some women, we obtain bladder testing called urodynamic testing to give us more information about your bladder and urethra. We talk with you about your preferences, goals, medical and surgical history in determining which surgery is best for you. Most women will recover from surgery within 2 to 4 weeks.
Surgical procedures:
- Mesh midurethral slings
- Autologous fascia slings (non-mesh slings)
- Laparoscopic Burch urethropexy (non-mesh laparoscopic surgery)
- Urethral bulking
