by Samir Derisavifard, MD
Every year, millions of women cope with urine leaks. They may be laughing, sneezing, exercising or bending over to pick up something. Any movement that puts pressure or stress on the bladder can start a leak. That’s why it’s called stress incontinence (SI). It mostly happens to women over 40, but younger women can be affected too, and lots of women struggle with it.
It’s a sensitive topic. Most women don’t talk about it. Less than 10% get help. I’ve found some women are comfortable living with SI. I see women who wear two or three pads a day and are fine with that.
If a woman is bothered by leaking, she doesn’t have to live with it. It’s not a normal part of aging, and there are treatment options.
First step to living leak-free
With incontinence, there isn’t a one-size-fits-all treatment. It’s important to know which type we’re dealing with. If a woman thinks she has SI, I do a pelvic exam. This determines what kind of care may be best.
Watch for signs of improvement
The most conservative choice is to do nothing and watch the situation. Many women experience SI after childbirth. Some of these cases clear up on their own, but often they don’t.
For women who want to start slowly, I may suggest pelvic floor therapy with a physical therapist who will teach women ways they can strengthen their pelvic floor muscles to reduce or stop leaks. Pelvic floor therapy is 30% effective in patients with slight incontinence.
Block the leak
For women who want move than pelvic exercises, a pessary can be a good choice. They are plastic inserts placed in the vagina. They push up against the urethra. This extra support stops leaks. These are often good options for younger women who leak when they exercise, garden, hike or are active. You can wear it for those activities, then take it out when you’re done.
A throw-away pessary can be found at many retailers. It’s called the Impressa® tampon.
Bulk up to leak less
For more long-lasting protection, a bulking agent is placed into the lining of the urethra to thicken it. Afterward, the bladder doesn’t leak. I can give a bulking agent in the office. It works in many older patients who don’t want surgery, but want something done. They’re also good for younger patients.
The only downside is they can lose their effectiveness. Half of patients stay dry two years, but the other half have SI symptoms again.
The gold standard to take care of leaks
A urethral sling is effective and has been used for decades. It works right after the 45-minute outpatient surgery. In most cases, a small ribbon of mesh is implanted under the urethra to support it. About 90% of women see improvement with the sling. Between 75 to 85% stay completely dry. We also have data showing the sling is effective 10 to 15 years.
It's also very safe. The chances of major problems is less than 5%. The use of mesh has not been linked to higher chances of infection or pain.
The surgery requires three small incisions about the size of a finger nail. Two made above the pubic bone or inner thigh and a third inside the vagina. A sling can also be made from a patient’s own tissue. Because it involves collecting tissue from the leg or abdominal wall, the incisions are larger. It’s important to know recovery for this is often longer and more difficult. Plus, a woman’s tissue isn’t as durable as the mesh.
A urologist can make a difference
In all cases of SI symptoms, I suggest evaluation by a urologist. It’s important to know what we’re dealing with so we can find the best care plan.
I can’t tell you how many women I help say, “I don’t know why I was so scared of. This was not nearly as big a deal as I thought.”
If you have issues with leaks, don’t feel intimidated or ashamed. Speak with a urologist.
To schedule an appointment with Dr. Derisavifard, who specializes in female pelvic medicine and reconstructive surgery at USMD Center for Advanced Pelvic Medicine & Bladder Health, call 1-817-784-8268. You can also make an appointment online.