A cough. A sneeze. A laugh. Lifting something heavy. Or even just standing up.
For the 17.5 million women with stress urinary incontinence, something as simple as a sudden movement can cause potentially embarrassing leakage.
But stigma should not keep women from seeking treatment, experts say.
Things have changed dramatically since the times of our mothers and grandmothers, and there’s now more help than ever.
“There is a great deal of awareness of stress incontinence now going on nationwide, and there are many treatments available,” said Raisa Platte, MD, a Spectrum Health surgeon who specializes in female pelvic medicine and reconstructive surgery. “We want to stay young and be active and travel. We want to be able to enjoy things. Stress urinary incontinence should not be an obstacle to do that.”
What is it?
Stress incontinence affects about 20 percent of women, making it the most common type of incontinence.
It happens when certain movement or activity puts stress or pressure on the bladder, resulting in urine leakage. It can be prompted by coughing, sneezing, hard laughing, heavy lifting or exercising.
Another common type of this ailment is urge incontinence, or overactive bladder. This happens when a person has an unprompted strong and sudden need to urinate.
A doctor can help women determine what kind of incontinence they have and how to treat it, Dr. Platte said.
What causes it?
One of the major causes of weakened pelvic floor muscles is pregnancy and childbirth, Dr. Platte said. That could be why it’s so common.
“We do believe that multiple births can make it more severe, but we also know that pregnancy itself can cause some stress urinary incontinence because of the increased pressure in the abdomen,” she said. “If it does not resolve after pregnancy, it definitely can progress and become more of a concern.”
Other causes include obesity, chronic cough (from asthma, smoking and other conditions) and genetic predisposition.
What can you do to prevent it?
Women can take an active role in fighting the problem:
- Reach a healthy weight. Research shows that obesity plays a big role, Dr. Platte said. “If you are able to lose 8 percent of your body weight, leakage risk decreases by 50 percent,” she said.
- Quit smoking. While this will have other positive impacts on your health, it also helps reduce stress urinary incontinence by reducing chronic cough, chronic obstructive pulmonary disease, and other pelvic floor stressors.
- Take care of your bladder. Limit caffeinated drinks and drinks with artificial sweeteners, which can irritate your bladder. Don’t hold your urine for a long time. You should urinate every three hours, or four to seven times per day.
- Do Kegel exercises. This helps to improve muscle tone in your pelvic floor. “This is very hard for women to remember. We are all the time on the go,” Dr. Platte said. “So I tell patients, when you are driving and stop at a red light, do your Kegels. ‘Red light, Kegel tight.’”
How do you do Kegel exercises?
Jennafer Vande Vegte, a physical therapist with the Spectrum Health Pelvic Rehabilitation Program, offers these tips for Kegel exercises:
- Some people think of stopping the flow of urine or holding back gas as a cue to find these muscles. That’s fine, but don’t regularly stop the flow of urine—it can cause other problems.
- Imagine you have a marble in your pelvis. Imagine squeezing the marble and lifting it up to your nose.
- If you still have a hard time finding these muscles, there’s a new device that can help. It’s called the kGoal, and it’s designed to be inserted into the vagina to sense your pelvic floor muscle contraction. It then communicates via Bluetooth technology and a smartphone app to give you feedback on your Kegel performance.
- Don’t follow the old “100 Kegels a day” adage. Do two to three sets of 10 fast Kegels (squeeze, release) and two to three sets of 10 slow Kegels (squeeze, hold, release), spaced throughout your day. Start with holding for four seconds and work your way up to the goal of 10 seconds.
What if you already have incontinence?
First, women with incontinence should see a doctor, Dr. Platte said. There are different kinds of incontinence and different causes, and only a doctor can figure out the best plan.
There are many approaches beyond Kegels, weight loss and such.
New devices on the market are much better than pads, which simply absorb leaked urine.
The Poise Impressa Bladder Support, which hit drugstore shelves a year ago, is an over-the-counter, tampon-like device inserted into the vagina to support the urethra and prevent urine from leaking.
A vaginal pessary, a device inserted and fitted by your doctor to sit on each side of the urethra, is also helpful for some women.
There are also surgical treatments available to women who do not have success with other treatment, Dr. Platte said.
Your doctor might also refer you to physical therapy through the Spectrum Health Pelvic Rehabilitation Program. The program works with stress incontinence patients to figure out what’s causing the problem—and patients have seen a lot of success correcting it, Vande Vegte said.
“The whole abdominal and pelvic area acts as a system—your diaphragm, abs, pelvic muscles, pelvic joints, back and hip muscles,” she said. “They all should be interacting in a smooth, coordinated way.”
Weak pelvic floor muscles are a common problem, but in some patients the pelvic floor is actually too tight, so the muscles lose their range of motion and cannot function well.
The field of pelvic floor rehabilitation has been around for about 15 years and has exploded in popularity recently.
“Women today are more willing to talk about these issues and not settle for wearing pads and staying inside,” Vande Vegte said. “We’re active and we want to have a life.”
Dr. Platte agrees.
“Although this doesn’t seem like a condition which can make you medically sick, this is a condition that can affect your quality of life in so many ways,” she said. “There are treatments available, so see your doctor.”