Don’t stress over urine leaks
Let Esther Han, DO, help
March 16, 2021
Every year, millions of women find themselves coping with urine leaks. They may be laughing, stifling a sneeze, doing crunches at the gym or just bending over to pick up something.
Any physical movement that puts pressure (or stress) on the bladder can start a leak. That’s why it’s called stress incontinence (SI). It most often happens to women over 40, but younger women are affected too. One out of three women experiences SI at some point in their life.
It’s a sensitive topic. Most women don’t talk about it. Less than 10% of women get help. I’ve found that some women are very comfortable just living with SI. I see women who are wearing two or three pads a day and are fine with that.
If a woman is bothered by leaking, I want her to know she doesn’t have to live with it. Just because your mom or grandmother dealt with it doesn’t mean you should. It’s not a normal part of aging, and there are a variety of good 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.
Once we know SI is the issue, we can think about what kind of care may be best based on her age, medical history and how much she leaks.
Watch for signs of improvement
The most conservative choice is to do nothing. A period of watching the situation is always a choice.
Many women first have SI after childbirth. Some of these cases clear up on their own, but many times they don’t. The more children you have, the greater your chances of having this problem.
For women who want to start slowly, I may suggest pelvic floor therapy with a physical therapist. They teach women ways they can strengthen their pelvic floor muscles to reduce leaks or stop them before they happen.
Pelvic floor therapy can be very effective. It’s important to remember though, it is exercise so if you don’t use the muscles the effects can wear off.
Block the leak
For women who want to move beyond pelvic exercises, a pessary can be a good choice. They are plastic inserts that come in different sizes and shapes. They are placed in the vagina and push up against the urethra.
This extra support stops leaks. These are good options for women who leak when they exercise, garden, hike or do anything 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. A handful of my patients use this method and like it.
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.
The nice thing about a bulking agent is I can give them in the office. They’re quick and easy. It works in many older and frail patients who don’t want surgery, but want to have something done. They’re also good for younger patients who are not able to take a few weeks off for recovery. One day of downtime is all I ask.
There is good seven-year data that shows over 90% of women are happy with a bulking agent. And, less than half of women need a touch up in those seven years.
The gold standard way to take care of leaks
A urethral sling is very effective and has been used for decades. In fact, 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 some improvement with the sling. Between 75 to 85% stay completely dry. We also have good data that shows the sling is effective for 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 may only require a small incision 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 keep in mind that 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 a full evaluation by a urologist so we can find out which form of incontinence is causing the biggest problem and address it. 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 what I was so scared of. This was not nearly as big a deal as I thought. I don’t know why I didn’t come in sooner.”
If you’re having issues with leaks, don’t feel intimidated or ashamed. Speak with a urologist. At USMD, we’re here to help. I try to empower my patients to be informed and guide them in making decisions that work best for them.
Do you struggle with stress incontinence?
To schedule an appointment with Dr. Han, who specializes in female pelvic medicine and reconstructive surgery at the USMD Center for Advanced Pelvic Medicine & Bladder Health, call 1-817-784-8268. You can also make an appointment online.
The information provided is for general informational purposes only and is not intended to be medical advice or a substitute for professional health care. You should consult an appropriate health care professional for your specific needs.