Don’t live with urinary incontinence. Help is available

Some women have to deal with unpleasant body issues every day. A common one is peeing when you sneeze, cough, laugh hard or exercise, otherwise known as stress urinary incontinence.

This type of bladder leakage, or urinary incontinence, accounts for 50 percent of all the cases of incontinence I treat. Many women don’t think twice about crossing their legs when they cough hard or sneeze. It’s normal after having kids or as you age, right? No. It’s common, but it’s not normal.

Pee a little when you cough/exercise? It may be stress urinary incontinence, an abnormal condition we can treat. via @MedStarWHC

Stress urinary incontinence happens when the muscle that closes off the bladder (the sphincter) doesn’t work as well as it should. This can happen when the sphincter nerves, muscle or both get damaged, which often is caused by vaginal childbirth. This type of bladder leakage also can happen because of intrabdominal pressures and other changes that happen as women age.

But there are highly effective, minimally invasive treatments that can cure this common, but not “normal,” condition.

What should you do if you have bladder leakage?

First, see your primary care doctor or gynecologist to rule out possible infections, like urinary tract infections. If nothing is wrong, but you still experience symptoms, it’s time to see a urogynecologist.

Urogynecologists are specially trained in pelvic floor conditions like stress incontinence. Medication usually won’t work to treat this type of bladder leakage, but there are many treatment options that we can recommend. Cutting down on fluid consumption, doing Kegel exercises to strengthen the pelvic floor muscles and urinating on a schedule can help keep symptoms at bay if you have just a little bladder leakage.

But if the leakage is enough to affect your quality of life, I’ll be honest—none of these will be as effective over time as a simple outpatient procedure. Urogynecologists perform a higher volume of incontinence procedures compared to general gynecologists, which improves your chances of a good outcome.

Request an appointment to discuss bladder leakage problems with a urogynecologist.

Midurethral sling surgery for stress urinary incontinence

The gold standard of stress urinary incontinence treatment is a midurethral sling procedure. It’s the most studied, most effective treatment for stress bladder leakage, and it’s highly effective with low risk. Women’s happiness rate for the surgery is 80 to 90 percent.

Please note: This is not the same mesh sling you may have seen in lawsuit commercials on TV or online. That’s for an entirely different issue called vaginal prolapse.

Sling surgery for stress urinary incontinence takes just 20 minutes, and we do it in the office. You’ll get local anesthesia and light sedation, which means we don’t have to put you all the way to sleep. Then we make a half-inch incision inside the vagina to access the urethra—the tube through which pee exits your bladder. From there, we use a tiny mesh sling that supports the urethra to prevent bladder leakage from sneezing, coughing and other day-to-day functions.

Most women can expect rapid recovery, including leaks stopping almost immediately. Half of our patients can urinate normally right after surgery. The other half go home with a 3-inch catheter for just a few days. Of those who take a catheter home, 90 to 95 percent of them can pee normally within three days. If they can’t go normally after three days, the mesh may be a little too tight, and we can loosen it to get them flowing normally again.

I’ve learned in my long career never to tell people how much discomfort they’ll have after surgery, because everyone is different. But most women have minimal to no issues. Still, we recommend they avoid placing anything in the vagina for the first 2 weeks. That means avoiding sex and the use of tampons, for example. We also recommend avoiding extreme exercise, such as heavy weightlifting and endurance running. In the first few days after surgery, women can start back to light exercise, such as walking or moderate running.

If you’ve had complications with synthetic mesh surgeries in the past, this may not be the right procedure for you. Your doctor can help you find an alternative to cure your urinary stress incontinence.

Urinary leakage is a common problem, but it can be fixed. If you’re tired of crossing your legs to sneeze or losing urine when you exercise, come see us. We’ll find a solution to fit your condition and lifestyle.

What women need to know about pelvic floor disorders

Women often find it embarrassing to talk about pelvic floor disorders—a broad category of issues also called pelvic floor dysfunction. These issues often stem from weakening or injury of the muscles and connective tissues of the pelvis. But these conditions are common, and women should feel comfortable discussing them with their doctor.

A 2014 study found that 25 percent of U.S. women have at least one pelvic floor disorder. That’s only the number of women who have reported it; the actual number is likely quite a bit higher. By age 80, half of U.S. women will experience some type of pelvic floor disorder.

25% of U.S. women have at least 1 #pelvicfloor disorder. via @MedStarWHC

Women often believe that the symptoms of these disorders are just a part of getting older or a side effect of having children, and there’s nothing that can be done. But that’s not true. While aging and giving birth do increase the risk, there are techniques and treatments available to give women relief.

Types and causes of pelvic floor disorders

There are several forms of pelvic floor disorders, such as:

  • Pelvic organ prolapse: Downward movement or dropping of the pelvic organs, including the uterus, vagina, bladder and rectum.
  • Stress urinary incontinence: Leaks of urine that can happen when a woman coughs, exercises or sneezes.
  • Urgency incontinence: Problems holding back the urge to urinate.
  • Fecal incontinence: Leakage from the bowel, ranging from gas to stool.

Many factors can contribute to a woman developing a pelvic floor disorder, including:

  • Pregnancy and delivery
  • Injuries during a hysterectomy or some other surgical procedure in the pelvic region
  • Obesity
  • Strain in the abdomen, or belly, such as lifting heavy objects

Pelvic floor disorder treatments

Women may be able to improve mild symptoms through changes in their behavior. Decreasing the amount of fluid you drink per day means the bladder isn’t as full, which can make it easier to hold back urine. Scheduled bathroom breaks or Kegel exercises to strengthen the muscles of the pelvic floor also can help.

Another non-surgical option for urinary leakage and pelvic floor relaxation is a “pessary,” which is a device similar to a diaphragm used for birth control. The device is inserted into the vagina and provides support for the pelvic organs. Some women use pessaries all the time, while some only use them during the daytime. They need to be cleaned regularly to prevent infections.

Surgery for pelvic floor disorders

If behavioral changes or a pessary don’t work, or if a woman doesn’t want to try a pessary, minimally invasive surgery is an option to treat many pelvic floor disorders. The more surgeries a doctor or hospital does to treat these conditions, the better outcomes are for patients. Our pelvic floor disorder program is the largest such program in the country.

Surgery to correct pelvic floor disorders used to be very invasive, but nearly all of these procedures are minimally invasive today. We can perform these surgeries either through the vagina or laparoscopically, which involves tiny incisions in the abdomen. These surgeries are often performed as an outpatient, without the need for a hospital stay.

Minimally invasive surgical procedures have several advantages over traditional surgery, such as:

  • Fewer complications
  • Less pain and discomfort
  • Shorter hospital stay, if a stay is needed at all
  • Quicker return to work and normal activities

Some women may have been told in the past that they’re not good candidates for minimally invasive surgery to treat these issues. There are very few reasons nowadays for women to need open surgery for pelvic floor disorders. This might be more of a reflection of the surgeon’s expertise than anything else.

Our program is well known for our expertise in this area of surgery. When I came to MedStar Washington Hospital Center in 2005, I was the first surgeon in Washington to perform a minimally invasive sacralcolpopexy, which is a procedure to lift the vagina. And we were one of the first centers in the world to perform robot-assisted pelvic floor surgery. In fact, we are a recognized Center or Excellence in the treatment of pelvic floor disorders, and are one of the largest programs in the country training doctors in female pelvic medicine and reconstructive surgery.

Bathroom trouble and pelvic relaxation aren’t just normal symptoms of getting older. These are common conditions that we have the tools and expertise to treat. I urge all women who are suffering with these symptoms to ask their doctors for help. We can help you get your life back.

Request an appointment with one of our urogynecologists to explore your options for treating pelvic floor disorders.