It doesn’t take much to trigger a leaky bladder — simply exercising, sneezing, laughing or coughing can cause embarrassing urine leakage. This condition, called stress urinary incontinence, is one of the most common problems facing women and can strike at any age.

“Sadly, many women often live with the condition for years without realizing anything can be done about it. Or, they’re simply reluctant to talk about it,” BCH gynecologist Jeremiah McNamara, MD, with Boulder Women's Care told a crowd of more than 100 people during a free health lecture held on March 8 in Boulder.

“In fact, more than half of women with stress incontinence do not seek treatment. But it doesn’t have to be this way," Dr. McNamara said. "Because of the serious effect it has on a woman’s physical activities and enjoyment of life, the problem demands serious attention.”

The Culprit: A Pelvic Floor Disorder
If you suffer from stress incontinence, then you have what is known as a pelvic floor disorder.

The pelvic floor is a complex group of muscles and tissue that form a “hammock” across the pelvis. It keeps the uterus, bladder, bowel and other pelvic organs in place.

“A range of issues can weaken or damage that hammock,” explained Dr. McNamara. “This can make one or more of the organs stop working properly, leading to a pelvic floor disorder. The most common of which is stress urinary incontinence.”

Causes of Stress Incontinence
One type of pelvic floor disorder associated with stress incontinence is pelvic organ prolapse, which means a drooping of organs. Weakened muscles in the pelvis cause the bladder to drop down into a position that prevents the urethra from closing completely. The result is urine leakage.

According to Dr. McNamara, there are number of things that can put you at risk for pelvic organ prolapse, especially as you age:

  • Vaginal childbirth (the number one risk factor)
  • Loss of estrogen from aging
  • Obesity (those with a BMI greater than 25 have a two-fold higher risk)
  • Chronic constipation

Besides urine leakage, women with pelvic prolapse can also experience the following:

  • Chronic urge to urinate
  • Vaginal fullness or pressure
  • Low back or pelvic pain
  • Constipation, straining or pain during bowel movements
  • Painful intercourse

In severe cases, women can feel tissue bulging or protruding through the opening of the vagina.

Pelvic organ prolapse isn’t the only cause of stress incontinence. “Weakened muscles in the pelvic floor stemming from physical changes to the body can also trigger a leaky bladder,” Dr. McNamara noted.

Reasons for weakened pelvic floor muscles include:

  • Pregnancy
  • Childbirth
  • Menopause
  • Overuse of bladder irritants such as coffee, alcohol or carbonated beverages
  • Obesity
  • Smoking

How Is Stress Incontinence Treated?
Dr. McNamara said the best place to start is by trying the following lifestyle changes:

  • Losing weight loss
  • Increasing physical activity
  • Aggressively treating constipation
  • Smoking cessation
  • Treating a chronic cough
  • Avoiding bladder irritants

The next step would be these treatments:

  • Pelvic physical therapy to strengthen pelvic muscles, improve bladder function and address any pain related to the pelvic floor disorder. Physical therapy can include soft tissue mobilization, biofeedback, deep tissue massage, heat and cold therapy and transcutaneous electrical nerve stimulation (TENS).
  • Daily Kegel exercises to strengthen the pelvic floor muscles.
  • Mechanical treatments such as a vaginal pessary — an internal support device that helps hold pelvic organs in place — and over-the-counter bladder supports that gently lift and give support to the urethra.

Surgical Treatment Options
When conservative treatment doesn’t work, there are surgeries designed to help keep the bladder in place and treat stress incontinence.

“If you need surgery, there are options with a short recovery and good success,” Dr. McNamara said. “For prolapsed or dropped organs, we can often repair the affected tissue vaginally – with no belly incisions. In most cases, this is a minimally invasive procedure performed on an outpatient basis.”

He added, “If the problem is weakened pelvic floor muscles, a bladder sling is an effective surgical option.” This same-day procedure involves a single 1 cm incision in the upper vagina. The surgeon places a net-like sling made of mesh to support part of the urethra or bladder and eases pressure on urethra.

“Studies show this sling procedure has a cure rate of 71 to 97 percent at one year, and that rate is maintained at 5 years,” Dr. McNamara explained.

If you wish to schedule an appointment with Jeremiah McNamara, MD, call (303) 441-0587.

Click here to view PowerPoint slides from Dr. McNamara’s lecture on “The Latest Treatments for a Leaky Bladder or Prolapse.”

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