Ugh. You were having such a great time. Maybe you were enjoying a laugh with friends or having a romantic dinner when you sneezed … and then it happened. You accidentally peed. As distressing and uncomfortable as the experience can be, it’s important to know that stress urinary incontinence (SUI) isn’t uncommon and, more importantly, is very treatable.
According to Dr. Deepali Maheshwari, DO, MPH, FACOG, urogynecologist at Baystate Urogynecology, “Up to one in three women experience SUI at some point in their lives. It can change in severity over time and, in some cases, resolve on its own. We treat based on degree of bother and effect on quality of life. It is your choice.”
What’s behind a leaky bladder
Even though we tend to blame our bladders for accidental leakage, the problem really stems from issues related to the urethra. Maheshwari explains, “The urethra is the tube that carries urine from your bladder to the outside world. Normally, the tube is supported by your pelvic floor muscles—a hammock-like group of muscles that support the bladder, rectum, and uterus. When those muscles become stretched or weakened, the urethra may not be able to fully close or hold your urine in.”
She adds that accidents are most likely to happen when there’s some sort of force exerted on the abdomen. Things like laughing, coughing, and sneezing, or even being constipated can result in leakage.
While anyone with a vagina can experience SUI at any time in their life, your chances of developing it increase with age—especially if you’re post-menopausal—and after pregnancy and vaginal childbirth.
And, yes, we all age and many of us give birth to babies, but Maheshwari notes, “SUI is not normal, and it isn’t something you have to learn to live with.”
Diagnosing Stress Urinary Incontinence
If accidental leaks are preventing you from doing things you’d normally do or are making you feel nervous or uncomfortable in social settings, it’s important to see a doctor to discuss your concerns.
Maheshwari explains that diagnosing SUI is relatively simple. “First,” she says, “you complete a form detailing your medical history and your experience with leakages. We then do a targeted pelvic exam to assess your pelvic floor and conduct a bladder test that involves emptying and filling the bladder and sometimes having the patient cough to get a sense of the degree of leakage occurring.” Acknowledging the test can be bit uncomfortable—a full bladder often is— Maheshwari adds it is relatively quick and extremely helpful in determining the right course of treatment for each patient.
Treatment options for stress urinary incontinence
How SUI is treated depends largely on how much it bothers the individual. Here’s a look at some of the most common treatment options, ranging from non-invasive to surgical.
Self-directed Pelvic Floor Muscle Training
As the name suggests, this option works to engage the muscles in your pelvic floor to regain strength and control of your urethra. Commonly referred to as Kegels, this option works for up to 60% of patients if performed correctly. However, like any muscle building routine, it’s not a one-and-done deal. “You have to consistently perform Kegels in order to get the full and ongoing benefit,” says Maheshwari. “The good news is they’re very easy to do and can even be performed while you brush your teeth or stand in line at the grocery store.”
She adds there are several apps available that provide videos on technique and daily reminders to keep up with your training. Some popular apps include:
Pelvic Floor Physical Therapy
This is a specialized type of physical therapy that focuses on treating and strengthening the pelvic floor. A pelvic floor physical therapist will make sure a patient is performing Kegels correctly, use biofeedback to help patients understand how the pelvic floor is responding and functioning, and may perform some internal vaginal work. Working with a physical therapist is a great way to ensure you’re progressing towards better bladder control and—good news alert—it’s usually covered by insurance.
Pessaries
A pessary is a soft, removable device that’s inserted in the vagina and lends support to the pelvic floor and urethra. Typically made from silicone, they’re reusable and come in a range of sizes with 75% of patients reporting remaining dry when used. Your doctor will do a fitting in their office to ensure the pessary is comfortable and properly sized for your body and needs. Pessaries can be worn for three to four months at a time and then removed for cleaning. Disposable pessaries are also available online and can be worn for up to 12 hours at a time. Note: all types of pessaries should be removed for intercourse.
Midurethral Sling
First introduced in 1996, this surgical option is 80-90% effective. The day-surgery involves implanting essentially a mesh scaffolding in your pelvic floor which your body heals around. It then provides permanent support to your bladder and urethra.
As noted, this is a highly effective option with the procedure causing minimal pain. There are some temporary restrictions post-surgery including no heavy lifting or high-impact exercise and nothing in the vagina for six weeks.
Urethral bulking
Urethral bulking is a good option for individuals not interested in mesh or for those still experiencing leaking after surgery. This procedure involves injecting a bulking agent, typically a water-based gel, within the wall of the urethra to narrow its diameter. Most patients experience a 60-70% improvement in leakage with the agent lasting up to seven years. Unlike a midurethral sling, this option does not require an incision and there are no post-procedure restrictions.
Should I talk to my doctor about leakage?
If accidental leaks are a regular part of your life, talk to your doctor. SUI isn’t something you have to just accept and learn to live with. There are lots of treatment options available to help you feel confident in your body again and live your life as fully as you want.
Talk to your doctor or reach out to our team to discuss your leakage concerns.