Stress Incontinence: Troubling but Common with a Range of Treatments

Many women suffer the embarrassment and discomfort of stress incontinence, where urine leaks with a sneeze or cough. In answering questions at a recent public event, two experienced Gynecologists discuss the problem and possible solutions.

  • Here are the highlights of comments by Drs. Campbell and Hardenbergh:
  • Incontinence is something we see all the time, because it’s a very common condition to many women.
  • There are many different risk factors that you can have for what we call stress incontinence.
  • Stress incontinence is when the bladder is unable to hold urine with increased abdominal pressure, whether you’re bending over and picking something up, laughing, sneezing or whatever it is you do.
  • The movement causes the pressure inside your belly to push down on top of your bladder. You are born with an angle or kink at the neck of your bladder, but over time for various reasons — some genetic, having children, chronic cough, chronic constipation — the kink is straightened out. As a result, any pressure from above just pushes urine out.
  • There are a variety of ways to treat it. In the past, doctors made a large incision on the abdomen and suspended the bladder. More recently, pelvic floor exercise or physical therapy is where we start.
  • From there, we go to minimally invasive procedures. One is called the mid-urethral sling. We use a piece of mesh – about the size of a shoestring – between the vagina and the bladder to recreate that angle. The incision is only about a half inch. About 85-90 percent of the time it will be a cure for women. Two to three years after the surgery, about 95 percent of women are very happy they’ve had it done. So, it is a minimally invasive, outpatient procedure that is very effective.
  • There are some medications that you can take. The main problem with a lot of the medications that you take is side effects. Typically, there’s dry mouth. Women will say, “I was walking about, took the pill and now I feel like I have sandpaper I my mouth.” There is a new medication called Myrbetriq that doesn’t have any significant side effects. It’s very effective and has made big changes in the way we practice.

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