Urinary Stress Incontinence

In my last blog, I discussed loss of urine caused by bladder spasms. Today, we will discuss loss of urine due to an anatomical change in the support of the urethra called Urinary Stress Incontinence (USI).

The urethra is the small channel that drains the bladder. The bladder and the urethra are supported by thick tissue called fascia. Having children, age, loss of estrogen, weight gain, and gravity can all disrupt this natural support leading to increased mobility due to loss of support of the urethra, which can in turn lead to loss of urine. Women who have urinary stress incontinence complain of loss of urine when coughing, sneezing, laughing, running, or doing any strenuous activity.

The most basic treatment for USI is trying to strengthen the muscles of the pelvic floor. This can be accomplished by doing Kegel exercises. The easiest way I can describe how to perform Kegel exercises is by telling my patients that the muscles to target are the ones we use to stop the flow of urine while sitting on the toilet while urinating. For women who just can’t seem to isolate these muscles, physical therapy and something called Biofeedback can also be performed.

Pessaries are devices that can be inserted in the vagina to support the urethra and basically give back the support that has disappeared. Pessaries are worn all or most of the time and require more frequent exams of the vagina to ensure that there is no irritation of the vagina from the device.

Surgical management of USI has excellent results. There are newer techniques using a very small piece of mesh to create a hammock under the urethra for support. Most of the time this procedure is done as an outpatient. Most often, the procedure is called a transobturator tape, or TOT. Obviously, all surgeries have risk, which your provider will review with you if you decide to take this treatment approach.

There is no reason women have to live with uncontrollable loss of urine in this day and age. There are so many things we can do to help. Just let your provider know what symptoms you are experiencing.

Dr. Deb Herchelroath