Stress Urinary Incontinence: Something We Don’t Talk About

Disclosure :: This post is sponsored by Ochsner Lafayette General. 

Stress Urinary Incontinence: Something We Don’t Talk About

Stress Urinary Incontinence: Something We Don’t Talk AboutWhen my first child was two years old, we were at a friend’s house where several children were laughing and playing outside. My daughter was tugging at my shirt to join her and, of course, I obliged! I was a “Fun Mom.” Enthusiastically, I ran over and jumped onto the backyard trampoline. As I landed, I instantly knew – something was amiss. All the parts of my body that I once knew so well came crashing down. My insides felt loose. Then came the moment I realized what was happening… I had wet my pants. I got off the trampoline and dashed to the bathroom. But why had this happened? I felt lost. Why didn’t anyone warn me that women could experience this?

At the time, I was a resident in general surgery. I found out later in OB/GYN training that what I had experienced was actually my first encounter with Stress Urinary Incontinence. Stress Urinary Incontinence (SUI) is the involuntary loss of urine on effort, physical exertion, or with increased abdominal pressure upon sneezing or coughing. In general, urinary incontinence affects up to 62% of all American women (~78 million). SUI is one of the most common forms of incontinence affecting women today.

What causes stress urinary incontinence?

There are several factors associated with the development of SUI, such as increasing age, increasing weight (BMI ≧ 25), and prior vaginal births. The most common cause is a weakness of the pelvic floor, specifically, a group of muscles called the levator ani.

This can lead to not only incontinence, but also pelvic organ prolapse: the uterus, bladder, and rectum descending through the vaginal opening of the pelvic floor.

 How can you manage SUI?

While it may sound scary, there is good news. A variety of non-surgical and surgical ways to treat and manage stress urinary incontinence do exist.

Pelvic Floor Physical Therapy

Pelvic floor muscle therapy (PFMT) is first line treatment for SUI and it’s come a long way from Kegels. PFMT focuses on strengthening the muscles of the pelvic floor. Most treatments begin with therapists performing internal work, so you should expect something similar to a gynecological pelvic exam. This helps determine a baseline strength, which identifies weakened muscle groups and assesses progress. The success of PFMT depends on the frequency and intensity of the exercise. On average, it takes about five months before the pelvic floor shows signs of strengthening; however, some women see improvement in as little as six weeks.

 Bladder supports

Bladder supports are devices that are designed to form a cushion under the urethra.  When abdominal pressure is exerted on the bladder and urethra, the urethra is squeezed against this structure (think of a closing pipe) and leakage does not occur. Poise and Revive are available over-the-counter bladder. An incontinence pessary is a bladder support that is initially fitted in a doctor’s office. All three can be managed by the patient. None of these devices will “fix” SUI permanently, but they are a great alternative to surgery for people who have situation-specific SUI (i.e. only when I jog, or workout), and those that do not desire surgical intervention.

Urethral bulking

With urethral bulking, a bulking agent like collagen or a water-based gel is injected into the wall of the urethra. The purpose is to narrow the opening, which makes leakage less likely. This is a procedure that can be performed in a doctor’s office or the operating room as an outpatient. The advantage is that it can be performed quickly, there is little downtime, and you know right away if it worked. Urethral bulking is effective for 60-70% of women, but in some, the effectiveness decreases over time. The good thing about bulking is if the result achieved is less than desired, there is always the option of bulking again, or moving onto a sling.

Midurethral slings

A midurethral sling, in terms of surgical management, is still the gold standard. A sling attempts to replicate the path of the natural hammock the urethra sits in the body. The sling sits just under the middle of the urethra and acts as a “backboard” that compresses the urethra when pressure is exerted from above. It is greater than 90% effective in women with BMI <40, (higher rate of failure with BMI>40,) but this doesn’t rule out a sling as an option, and it is usually a long-term solution. There are two main types of sling: mesh and fascial. Each option has its own set of risks and benefits, and a discussion with your surgeon should yield the best option for you.

In closing, know what you’re experiencing is more common than you think, and you shouldn’t suffer in silence because help is out there. There are several great options for managing SUI, both surgical and non-surgical; some are even over the counter. The key is recognizing the issue and pursuing the best course of action for you.

Dr. Nika Vinson
After spending two and a half years in general surgery, Nika Vinson, MD, realized her passion was in women’s healthcare and pursued a residency in OB/GYN. After completing residency at Texas Tech University in Amarillo, Dr. Vinson stayed on for two years as a Dr. Nika Vinsonclinical instructor with the residency program. She then went on to a fellowship in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) in the urology department at the University of California Los Angeles (UCLA). At UCLA, Dr. Vinson developed a special interest in neuro-urology, urodynamics, robotics and complex pelvic surgery. After her fellowship, Dr. Vinson relocated to Baltimore, Maryland, where she was a member of both the OB/GYN and urology departments. Dr. Vinson was selected by her peers as a “Top Doctor” in Baltimore for Urogynecology/Female Pelvic Medicine and Reconstructive Surgery. Dr. Vinson’s extended family is from Louisiana, and when the opportunity presented itself, she jumped on the chance to relocate to Ochsner Lafayette General. Outside of the hospital, Dr. Vinson can be found dancing (Salsa!), learning a new language (she is bilingual – French/English, and am learning Spanish, Japanese and German), reading the latest sci-fi novel or training for a Spartan race. Dr. Vinson looks forward to starting this new chapter in Lafayette with Ochsner Health and serving the local community.


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