Stress incontinence is an inability to prevent the accidental release of urine that occurs when you sneeze, cough, laugh, jog, or do other things that put pressure on your bladder. It’s the most common type of incontinence in women.
Stress incontinence is most often caused by childbirth, weight gain, or other problems that stretch the pelvic floor muscles. When these pelvic muscles can’t support your bladder, the bladder drops down and pushes against the vagina. Unable to tighten the muscles that close off the urethra, women may experience urine leaking due to the extra pressure on the bladder.
What are the treatment options?
Incontinence can have more than one cause, so your doctor will treat the main cause first. Some treatments may include:
- Kegel exercises
These are also called pelvic floor exercises. They strengthen the pelvic muscles that control urination. You can do these exercises at any time without anyone knowing you’re doing them. Women who do Kegel exercises are more likely to improve, and even cure, their incontinence. These women had fewer leakage problems a day and said their quality of life was better. Adding biofeedback to Kegels helps them work even better to reduce stress incontinence.
These can be used to reduce how often you leak and improve your quality of life. But medicines rarely cure stress incontinence.
- Physical Therapy
Studies show that physical therapy can help incontinence sufferers in 85-90% of cases.
What about surgery?
Surgery for stress incontinence is usually done only after other treatments have failed. Surgery may be done when stress incontinence is severe and other treatments have not worked. Surgery lifts and supports the connection between the bladder and the urethra. While surgery is the most effective treatment for urinary incontinence in women, sometimes symptoms do return. Types of surgery include:
- Tension-free vaginal tape (TVT)
In this surgery, a mesh tape is placed under the urethra like a sling to support it and return it to its natural position. Surgery takes about 30 minutes and is usually done under local anesthesia. Another procedure called transobturator tape (TOT) surgery is like TVT. Both TVT and TOT cure stress incontinence in about 8 out of 10 women. That means that about 2 out of 10 women still have problems with incontinence after this kind of surgery.
- Retropubic suspension
This surgery lifts the sagging bladder neck and urethra by attaching support tissue to the pubic bone or tough ligaments. It requires general anesthesia and 2 or 3 days in the hospital. Depending on how it is done, surgery cures stress incontinence in about 8 or 9 out of 10 women in the first year. Five years after surgery, about 7 out of 10 women are still “dry.”6
- Sling surgery
This surgery involves making deep cuts in the belly to get to the bladder and urethra. The surgeon uses a piece of muscle, ligament, or tendon tissue or synthetic material to make a sling. The sling lifts the urethra back into a normal position. It requires general anesthesia and 2 or 3 days in the hospital. Sling surgery is usually done after other surgeries have failed. It works well to get rid of stress incontinence.
Talk with your doctor about things you can do to increase the chance of having a successful surgery. You may have better results if you lose weight or do Kegels before surgery. If you smoke, quit.