I Laughed So Hard the Tears Ran Down My Leg

There is a day in every woman’s life where she realizes that the world she lived in yesterday is gone. She has closed the door on her youth and fully entered womanhood. She’s reached a turning point where her life will never be the same. That day is the first time she laughs without thinking and accidently pees her pants.

Stress Incontinence is a common occurence among women. There are factors that contribute including pregnancy, childbearing, increased body weight, UTI, uterine prolapse and more. It is the most common type of incontinence and affects approximately 1 in 3 women in America. It is common and increases with age. May women have the occasional, incredibly rare, “only when I have a cold” version of stress incontinence and pelvic floor support exercises and weight loss if overweight can really help with this mild form.

What I’d like to talk about today though, is the more severe type. This version of stress incontinence affects women daily. May women find that they can no longer participate in activities they enjoy - jumping on the trampoline with the kids, jogging, dancing and even sexual activity. Why does this happen? There are two main reasons. The first is called Genuine Stress Incontinence and is caused by a combination of increased intraabdominal pressure and weak pelvic floor muscles. The second is Intrinsic Sphincter Deficiency (ISD), which is when the urethera is unable to close tightly and leaking happens even with normal intraabominal pressures. Because both types of incontinence are generally treated the same way, the only important distinction is that ISD makes it more difficult to get complete resolution of symptoms.

So, what can we do?

Step 1 - If you have sudden onset new stress incontinence, a UTI check with a urine culture is step one and shouldn’t be delayed. Especially as we age, there are fewer pain symptoms iwth UTIs and sometimes the first sign of infection is new onset incontinence. It’s also importnat to treat any infections because if left untreated, infection will stop everything else on the list from working and may cause really significant illness over time.

Step 2 - Exam time - There are some key things your doctor is looking for - do you have a drop in your bladder or uterus? Do we see the urethra dancing all over the place during a cough indicating urethral hypermobility? Do you have something putting pressure on your bladder like uterine fibroids?

Step 3 - Lifestyle Changes.

A. If your BMI is over 25, some weight loss is in order and fixing your unexpected pop-up water fountain is one of them.

B. Kegels - The next time you have to pee, try to stop midstream. (It’s ok if you can’t and once you know what muscles to work, please empty your bladder the rest of the way - see step 1). This teaches you to isolate the appropriate muscles. If you are tightening anything in your legs and butt, this isn’t the right spot. Once you find the right muscles, try to hold them tightly x 10 seconds. Repeat x 10. Do this all the time.

C. Pelvic Floor PT - There are physical therapist who specialize in training your pelvic floor muscles. They do amazing things to help with painful sex, pelvic pain, endometriosis, chronic constipation and other disorders involving the pelvic floor. By strengthening the pelvic floor, you can alleviate the symptoms of prolapse and gain more control.

Step 4 - Devices - there are over the counter devices like the Poise Impressa and several other interesting things that I don’t recommend googling if you are somewhere others can look over your shoulder. For people with mild symptoms, these may help prevent/limit symptoms, but require alot of insert/remove/replace cyles. There are also prescription devices like a Pessary (a silicone disc that stays in the vagina) that are fitted to an individual patient. These are left in place continuously. Some women remove, clean and replace them themselves and some women will see their GYN doctor every 3-4 months for this service. There are other devices like the Leva that are FDA approved for training the pelvic floor muscles. You put the device in and it helps you know you are essentially doing more effective kegels. There are also some “chairs” on the market that you sit on and it helps work you out. These cost 10s to 100s of thousands of dollars and yes, there is some literature to back them up, but they aren’t covered by insurance and are typically very expensive.

Step 5 - Surgery - There were many efforts through the years to find the magic bullet that would given women both good outcomes and minimal downtime. In the late 1980s, the Tension Free Vaginal Tape was born. This was/is a polypropylene mesh placed below the midportion of the urethra and coming up behind the pubic bone. This surgery remains the mainstay of stress incontinence treatment today. It is done through a 1 cm incision in the vagina and creates two poke holes in the mons pubis. It’s an outpatient procedure that takes approximately 15 min and causes fairly little downtime. The succuess is about 95% for genuine stress incontinence and 90-92% successful for ISD. Most women need a few days of rest after surgery and are recommended to avoid heavy lifting and long distance walking/running for 2 weeks. Due to its low pain level and high sucess rate, this surgery has become very popular. It is important to note that this isn’t the “bladder mesh” from lawyer commercial fame in the early 2010s. The same slings that were used in the 80s-90s are still being used today. At Advanced GYN and Wellness, we use the Boston Scientific Advantage Fit TVT. Dr. Moore has been placing this device for over 10 years. It works great and patient’s love the results.