Imagine the following scenario: You’re at your favorite comedy club with your family. You’re seated at the front, and the show is off to a great start. The comic is hilarious and right away she has everyone laughing. Unfortunately, you can feel it — little gushes of urine with each giggle. You knew this might happen, so you wore a small pad, but suddenly you can tell that it’s not enough. You’ve already scouted the route to the bathroom, but there’s no way to get there without excusing yourself as you walk in front of a row of people, hoping no one notices the smell or stains on your clothes.
Or this scenario: You’ve been motivated to start an exercise program thanks to an introductory deal at a local gym. Yet, when you start on the treadmill and increase the speed to a comfortable pace, you’re suddenly leaking urine with every step. You slow your speed, but soon your clothing is wet. You stop midworkout to go clean up.
These are examples of stress urinary incontinence — a common condition. Even though it can greatly impact quality of life, you may not hear much about it. There’s a lot of shame and stigma associated with the problem, despite it being so common. The good news is that there are many therapies available to help manage incontinence.
Even your bladder can get stressed out!
The outlet of the bladder is composed of the bladder neck — where the bladder meets the tube that drains the bladder (called the urethra) — and the urinary sphincter, which is a circular muscle that surrounds the urethra. The sphincter provides some external compression to this tube and helps keep urine in the bladder until it is ready to be released.
Stress urinary incontinence is often due to weakness of the bladder outlet. Risk factors that can contribute to this include pregnancy and vaginal delivery, obesity, chronic weight bearing or abdominal straining, and tobacco use. There may be some genetic links as well. With a weakened bladder outlet, you may experience involuntary leakage of urine after anything that puts pressure or strain onto the bladder, such as coughing, sneezing, laughing, bending, running or lifting heavy things.
What can I do about stress incontinence?
Typically, the first treatments to try for stress incontinence are conservative therapies. These include:
- Pelvic floor exercises (Kegel exercises). To identify the pelvic floor muscles, try to stop the flow of urine midstream. This will help you recognize which muscles need to be strengthened and how to squeeze those muscles. A simple exercise regimen would be to contract these muscles for 10 seconds. Do this 10 times, three times a day.
- Devices. Special devices can be inserted into the vagina that place gentle pressure along the wall of the urethra. They provide additional support to the sphincter. These devices come in various forms. They can be a pessary with a small knob on it. A pessary is a small ring or disk usually made of silicone that can be fitted into the vagina. Or they can be a specialized tampon-type device that can be purchased from a pharmacy or online.
What if conservative therapies don’t work or I can’t do them?
If conservative therapies don’t work, there are procedural and surgical options to manage stress urinary incontinence. Historically, several types of procedures to surgically treat stress incontinence have been used, but many of them have fallen out of favor due to the invasive nature of the procedure or the poor outcomes of the surgeries. Today, improved treatment options include:
- Midurethral sling. Currently, the gold standard therapy and most common surgery performed in the U.S. for stress urinary incontinence is a midurethral sling. Most often, the sling is a synthetic (mesh) material. This is generally an outpatient, same-day surgery that takes about 20 minutes but usually does require general anesthesia. Following the surgery, it’s best to refrain from strenuous exercise, heavy lifting, squatting, twisting or other activities that could increase pressure on the sling for about six weeks. This is to allow the sling to heal in a good position. There are nonmesh sling options as well. These slings are usually made by harvesting a strip of your own tissue. Surgeries that use this type of sling are longer and more complicated compared with mesh sling surgeries.
- Urethral bulking. Another procedure for stress urinary incontinence is urethral bulking. This can be done as an in-office procedure performed with local anesthesia only. Or it might be done in an outpatient surgery center. This procedure is performed by using a camera to visualize the inside of the urethra and then injecting a bulking material around the urethra or within the lining of the urethra to give additional support to this area. Many types of bulking materials are available. Ask your surgeon about specifics and the known pros and cons of the materials.
Is there anything new on the horizon for management of stress urinary incontinence?
There is ongoing research looking at the use of stem cells to regenerate the weakened muscle. This research is still in the experimental phase and has not yet obtained Food and Drug Administration (FDA) approval for use. There have been trials evaluating the role of different medications, but many of these trials were stopped because of complication rates, ineffective medications or both. There are reports that vaginal laser therapy may provide vaginal rejuvenation and cure pelvic floor problems such as incontinence and pelvic organ prolapse. But these claims are not currently supported by science. The FDA has issued an advisory against advertising vaginal laser therapy for these indications.
Who can I see for more information on stress incontinence?
Seek care by a specialist who has trained in the management of these conditions and feels comfortable performing these procedures and managing any complications that may result. Generally, these specialists are urologists who also trained in female pelvic medicine and reconstructive surgery (FPMRS) or a gynecologist who completed a fellowship in urogynecology.
