Stress incontinence, also called urinary leakage due to pressure on the bladder, is a common condition in women. Left untreated, it can affect a woman’s daily life and cause her to feel embarrassed about it.
Treatment can help reduce or eliminate urine leakage and improve a woman’s quality of life. It often starts with behavioral therapy to regain control of bladder function.
Pelvic Floor Exercises
In women, pelvic floor muscle exercise is often the first-line treatment for stress urinary incontinence. Studies show that these exercises improve urination control and decrease episodes of leakage in females with stress incontinence.
To do pelvic floor muscle exercises correctly, you need to target the right muscles. It’s easy to mistake your stomach muscles for the pelvic floor, but it’s important to do it the correct way – using only your vaginal muscles.
Stand with your feet flat on the floor, hip-width apart. Bend your knees while positioning your buttocks towards the floor.
Squeeze the muscles in your rectum as if you were trying to stop passing gas (or if you have had a tampon stuck in your vagina, imagine squeezing it up higher inside your vagina). Repeat this for five seconds and relax between each squeeze.
You should do this exercise three to four times a day. It takes time to build up strength and endurance for your pelvic floor muscles, so make sure you do it regularly.
Medications
If you have stress incontinence (urine leakage that happens when you cough, sneeze or lift something heavy), your doctor may prescribe certain medications to reduce urine leakage. These include antimuscarinics and mirabegron.
Other drugs, such as fesoterodine, oxybutynin and solifenacin, are also available to treat urge incontinence. These drugs may be less effective for some women, however, and have other side effects.
Other conservative treatments can reduce your risk of developing stress incontinence and help you to control it, such as losing weight and quitting smoking. Those changes, along with bladder training — tactics such as going to the bathroom at specific times, even when you don’t feel like it — may also reduce your symptoms.
Vaginal Inserts
A vaginal insert, also known as a pessary, pushes your urethra closed to prevent urine from leaking during activities that increase internal abdominal pressure. These include coughing, sneezing or laughing.
These devices are typically used for a short period of time, and may be prescribed by a specialised health professional. It is important to follow the instructions on the device and ensure that it is sized correctly for your needs.
Often, this is combined with pelvic floor physical therapy to strengthen the muscles of your urinary sphincter and bladder. Regular exercise is essential to achieve results, and it should be done under the guidance of a trained physical therapist.
If pelvic floor exercise and medication do not help, another alternative is nerve stimulation to control overactive bladder. These painless devices use electrical pulses to stimulate the sacral nerves that control the bladder.
Surgery
If non-surgical treatments like lifestyle changes, medication, and vaginal inserts haven’t helped you, your doctor might recommend surgery. Female pelvic medicine and reconstructive surgeons (urologists or gynecologists) who specialize in women’s health often perform urinary incontinence surgery.
Surgical techniques help reduce or stop urine leaks by supporting the bladder neck and urethra. The surgery can be done through your abdomen or vaginal opening.
Your doctor will attach the bladder neck and urethra to surrounding bone or tissue. Your surgeon may also use a mesh sling, tissue from your body called fascia, or other materials.
Recovery from stress incontinence surgery is usually slow and gradual, depending on the procedure and your general health. You need to rest and avoid strenuous physical activity and sexual intercourse for several weeks.
During your operation, your doctor will apply hemostats and suture materials to control bleeding. Your doctor will also wash your hands after the surgery and use sterile equipment.