Winter can be a busy time in my practice. With coughs and colds comes urinary stress incontinence for some women. Yes I chuckled when a patient joked “I wees when I sneeze” but it’s not funny and women shouldn’t have to put up with leaking urine.
What is stress incontinence?
Many women who have had babies, even by Caesarean Section, have a weakness in the tissue that supports the urethra (the urine outlet). During a cough or sneeze the pressure in the bladder rises and urine will leak out if the urethral valve is weak. Exercise can also be a trigger, particularly running and jumping. Also laughing. But, as I said, it’s not funny.
I’ve heard from many women that they gave up exercise because of urinary leakage. This leads to weight gain which often makes the problem worse! When a patient has her stress incontinence problem successfully treated, she can resume a full active lifestyle.
How is it treated?
Stress incontinence is best treated with a program that covers lifestyle change, physiotherapy and surgery.
Lifestyle change is primarily directed at weight reduction. Put simply, reducing body weight will reduce the forces applied to the bladder during events such as a sudden stop playing netball or running downhill. We work with dieticians and exercise experts for optimal results.
Physiotherapy programs are designed to maximize the strength and function of the pelvic floor. Our physio is provided in-house by Belinda Matthews. A study showed that more than 50% of women are unable to switch on their pelvic floor when asked. Belinda can assess whether you are switching on your pelvic floor correctly using ultrasound imaging and an internal exam and then set a program to help you learn what good pelvic floor exercise really means. Most times, physiotherapy is all that’s needed to regain continence. Other times it’s used to maximize the results of surgery.
For women requiring a surgical solution to stress incontinence, I use the TVT sling. I was fortunate to be working at the Royal Women’s when the procedure was first introduced and have been using the technique ever since. This day-surgery procedure places a band or “sling” under the urethra to give extra support. Most of the time the sling is inactive. During a sneeze or jump, however, the sling provides the necessary support to maintain continence.
Urethral slings are a minimal access (keyhole) procedure. Long-term follow up data has been published confirming their effectiveness. As with all procedures, risks and expected success rates must be discussed beforehand.
Women who come in to discuss their stress incontinence have usually had the problem for years! Ads for incontinence pads for “light bladder leakage” are infuriating. A leaky bladder was once considered part of “a woman’s lot in life” but modern approaches to treatment have gone a long way to properly solving this age-old and very common problem. Make an appointment.