Stress Incontinence

Question: Since my youngest child was born, I have been wetting myself when I cough, sneeze, run or play volleyball. At first it was mild, but lately I’m wearing pads or changing underwear. I don’t want to end up smelly and wearing diapers like my mother was late in life. What can I do?

Answer: This is called stress incontinence, when urine leaks with use of your tummy muscles. It usually occurs with coughing, sneezing, laughing, lifting or athletic activities.

Leakage comes from weak or ineffective urinary control muscles. The normal interaction of the control muscle (sphincter) and supporting tissue (fascia) between the bladder and vagina is weakened from childbirth effects, and worsened by menopause and aging. When abdominal muscles are stronger than control muscles, small leaks occur every time you use them.

Brief office testing (urodynamics), often with a bladder scope exam (cystoscopy), usually confirms the cause and severity of the problem. Different treatment options exist if testing confirms stress incontinence.

No FDA-approved pill currently exists like those for overactive bladder, but some are being studied for future use.

Pelvic exercises (Kegels) can be done by yourself, or aided by a specially-trained physical therapist who can add electrical stimulation to the exercises and achieve good results in 50 to 65 percent of motivated women without severe leakage.

Urethral plugs stop leakage when present only with occasional activities like weekly bowling or volleyball, but many women can’t use these.

Leakage from weak control muscles often improves with injections of materials to “bulk up” control muscles, done with a short office procedure.

Most surgeries today are minimally invasive sling surgeries, inserting a strip of your tissue or a mesh material to restore urethral support. Success rates are 85 to 90 percent, with same-day or overnight stays, smaller incisions, minimal pain, fewer side effects and less activity restriction compared to years past.