In a dramatic “oops” moment, the entertainer Marie Osmond got a fit of the giggles onstage during a recent performance—and, as she put it, peed in her pants. She earned the audience’s sympathy (and provoked more laughter) by admitting what she had done and poking fun at herself for the rest of the performance.
Only someone who has spent decades in the public eye could handle a “leak” with that much humor and aplomb. Most of us in the same situation would be mortified. But anyone can easily reduce personal discomfort—and the risk for public embarrassment—by taking some simple steps. Unfortunately, many people simply choose to “live with it.”
Stress incontinence—when you leak urine while laughing, sneezing, coughing or exercising—is extremely common. But many people don’t get help either because they’re too embarrassed to talk about it or they think that nothing can be done about it.
Stress incontinence occurs when the urinary sphincter, a ring of muscle, isn’t as strong as it should be. The muscle occasionally “slips” and allows urine to escape.
Women typically notice urine leakage for the first time during pregnancy or after vaginal childbirth, which can stretch and weaken the muscles that are needed for control. It also can start later in life, when muscles throughout the body naturally weaken. Men typically do not develop stress incontinence unless they have undergone prostate surgery.
Someone who leaks just a few drops of urine now and then might decide it’s no big deal. But if it’s happening every day, or you’re leaking so much that you’re going through multiple absorbent pads, you should see a doctor.
Your doctor first will look for underlying conditions—such as an infection or a neurological problem—that could be causing the problem. He/she also will want to confirm that you’re suffering from this particular form of incontinence. Other kinds of urinary incontinence include urge incontinence, characterized by a sudden, intense need to urinate, and overflow incontinence, which is an inability to empty your bladder completely.
Most cases of uncomplicated stress incontinence can be diagnosed just from a description of your symptoms—when you leak, how often, what you’re doing when it happens—as well as a stress test. Depending on your symptoms, medical history and prior treatments, your doctor may recommend more testing to confirm your diagnosis.
Pelvic-floor-muscle exercises, also known as Kegels, strengthen the muscles that give you bladder control. About 50% of those with mild-to-moderate problems can achieve nearly complete dryness with this approach alone. Pelvic-floor-muscle exercises often are recommended for men after undergoing prostatectomy.
Important: Even though the exercises are easy to do at home, I advise my patients to work with a specialist to learn them. A pelvic-floor physical therapist can help you identify the correct muscles so that you will know what they feel like when they contract and relax. Your doctor can refer you to a therapist. Typically, a physical therapy program consists of six to eight sessions, and then the patient’s symptoms are reevaluated.
If you’re doing the exercises without the help of a therapist…
Identify the muscles. When you urinate, try to stop the flow in mid-stream. Those are the muscles you need to strengthen.
Squeeze and relax. You can do this while sitting, standing or lying down. Squeeze the muscles as hard as you can for a few seconds, relax for a few seconds and then squeeze the muscles again. Each squeeze-relax cycle counts as one Kegel.
Do a series of Kegels two or three times a day. For each series, you’ll squeeze and relax the muscles at least 10 times—more as you gain strength. You can work the exercises into your day—while watching a movie, in the car at a stoplight, etc. Also, cutting back on caffeine may help with incontinence.
While many women will have improved bladder control with pelvic-floor-muscle exercises, further treatment may be necessary if you continue to have frequent or heavy leakage.
At this point, some women will opt for a surgical procedure to achieve continence. Surgery for men is far less common, and the main options are an artificial urinary sphincter or a sling.
Periurethral bulking. This is the simplest procedure for stress incontinence—and it can be done in your doctor’s office with a local anesthetic. A “bulking agent” is injected into the tissue that surrounds the urethra and urinary sphincter. Adding bulk to the area makes it more difficult for urine to leak out.
Advantages: There’s little to no recovery time. It’s a good choice for patients who might be too frail for surgery. Also, the injections can be repeated if you need more help.
Drawbacks: It’s not as effective as surgery. One study found that only 30% to 40% of patients who had this procedure were “dry” one year later.
Sling surgery. This is the procedure that most doctors recommend. Studies have shown that about 85% of patients who have it achieve total or near-total control.
During a sling surgery, a strip of polypropylene mesh or, alternatively, your own tissue taken from the thigh or abdominal wall is placed under the urethra, like a hammock. The extra support from the sling helps prevent leaks when patients cough, laugh, etc.
Drawbacks: It’s tricky to adjust the tension on the sling so that it doesn’t heal too tight. About 3% of patients will require a second procedure, known as “sling release,” to loosen the sling and allow them to urinate normally.
About 10% to 15% of patients may experience new “overactive bladder” symptoms after sling surgery, resulting in increasing urinary urgency and frequency despite the original problem’s being “fixed.” However, doctors often are able to treat these new urinary symptoms if they persist, and overall satisfaction with sling surgeries remains high (85% to 90%).
