FEATURE — Bladder control issues can really complicate life. But there are treatments and techniques that can help mitigate bladder leakage in women.
There are two main kinds of bladder control problems: overactive bladder and stress incontinence. This article will focus on stress incontinence.
There is a mechanism in the bladder that helps keep urine from leaking out when there is an increase in abdominal pressure, like when you are exercising, sneezing, laughing or coughing. That same pressure you generate with a cough or sneeze should also close off the bladder neck so no urine leaks out.
However, what can sometimes happen – and this is almost always related to pregnancy and childbirth – is that those supporting tissues at the bladder neck are stretched or damaged. When there is increased abdominal pressure that presses on the bladder, the bladder neck doesn’t close like it should because of damage to the underlying supporting tissue, and urine leaks out.
So what can be done? While surgery is an option for those who want to pursue more advanced treatments, there are a few things you can start with that don’t require surgery or even a doctor’s visit.
When you’re emptying your bladder and want to stop mid-stream, the muscular effort to do that is called a Kegel squeeze. Try practicing this muscular clenching periodically, even when when you are not going to the bathroom. This squeezing strengthens the posterior muscles of your pelvis and helps elevate it to give your bladder neck something to compress down on so it stays closed. It’s not perfect, but it can help.
If there are just some high-intensity activities that cause leakage, like working out, then using a continence pessary is a very viable option. These devices come in all shapes and sizes. You can buy them on Ebay or Amazon for around $30.
Since they come in different sizes, I’d just ask your gynecologist to fit you for one at your next office visit. Most women hate wearing a pessary all the time, but for just occasional usage, they can be quite effective.
What about medication?
Medications have been tried unsuccessfully with stress incontinence, so a pharmaceutical approach is not going to help.
Surgery is minimally invasive and, with well-chosen candidates, highly successful — there is a 90% patient satisfaction rate in well-chosen patients.
The state-of-the-art treatment is now to use a thin, synthetic mesh band. These are very different from large sheets of mesh used to repair vaginal prolapse that you may have heard about. The success rate with synthetic slings is very high, and complication rates are very low.
Just remember, you don’t have surgery because things might get worse; you do it when you get to that point where you say, “That’s it. I’m done. Let’s get this fixed.” It’s a quality of life issue.
- Dr. Sean Lynn practices at St. George Women’s Health Center in St. George | Telephone: 435-218-7770.
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