Ah, the joys of getting older and/or having babies. During these times in a woman’s life, it is not uncommon to develop stress urinary incontinence.

What is stress urinary incontinence?

Stress urinary incontinence (SUI) has nothing to do with how stressed you are about leaking urine. SUI develops when either the tissue that supports the urethra is weakened or when the pelvic floor muscles that support the bladder and urethra become weakened or don’t work right. If you leak with cough, sneeze, heavy lifting, running or jumping on a trampoline, you may have stress incontinence. Stress incontinence can be embarrassing or prevent you from doing the activities you love.

How can I stop the leaking? 

There are many things you can do to prevent the leaking. It is always a good idea to start by seeing your physician to make sure your leaking is truly due to SUI and not a bladder infection or anything more serious. Once you have been diagnosed with SUI, there are a variety of options for treatment.

Home Remedies

 1. Weight Loss

If you are overweight or obese, losing weight can lessen how often you leak urine by up to 70%.

2. Reduce Fluids

Stop drinking too much. Reducing your fluid intake is an easy way to stop leaking. Excessive fluids lead to a constantly full bladder, which makes you more likely to leak. A good way to gauge your hydration is to look at the color of your urine. A light yellow means you are well hydrated. If your urine is barely yellow at all, you are likely drinking more than you need.

3. Timed Voiding

Timed voiding means you make yourself empty your bladder at regular intervals even if you do not feel like you have to go. This prevents your bladder from getting too full which can lead to leaking urine.

4. Can the cough

If you are constantly coughing, try using cough drops or treating whatever is causing you to cough, like allergies (note: asthma or smoking can also cause frequent coughing). You would be amazed how much this helps.

5. Kegel exercises

Kegel exercises are pelvic floor-strengthening exercises. The pelvic floor muscles help support the bladder and the urethra. To prevent leakage the pelvic floor musculature and the sphincter muscle that surrounds the urethra need to contract. When your sphincter and pelvic muscles are weak, they don’t contract strongly enough to prevent leakage. (Kegels work about 50% of the time and need to be done daily to maintain the benefits).

6. Pelvic Floor Physical Therapy

If you have trouble doing your kegels, or your kegels aren’t working, consider seeing  a pelvic floor physical therapist. They can help you isolate the pelvic floor muscles and learn how to strengthen them.

Medical devices and medication

If the home remedies do not work, or you are looking for a more immediate solution, consider one of these:

7. Try an incontinence pessary.

A pessary is a small device that goes in the vagina and compresses the urethra, which prevents you from leaking. It can be worn all the time or just during the activities that cause you to leak. Your provider can fit and place it for you, or you can purchase some types online and  can place it yourself.

8. Low dose vaginal hormones

Estrogen revitalizes the tissue that supports the urethra. When estrogen declines, the amount of collagen in the tissue decreases, which can lead to less support of the urethra and other organs like the bladder, bowels or uterus. Low-dose vaginal estrogen can improve the surrounding supportive structures, increase the collagen content in the tissue and help with stress incontinence. Despite what you may have heard in the past, low- dose vaginal estrogen does NOT increase your risk of breast cancer, blood clot, heart attack or stroke and it can decrease your risk of bladder infections, also known as UTIs.

9. Duloxetine

Duloxetine is a drug used to treat depression and/or nerve pain. It also has been shown to decrease stress incontinence. Due to its side effects, and the many other options for treatment, Duloxetine isn’t used that often to treat stress urinary incontinence.

Hi-tech remedies

10. Vaginal laser treatment

Vaginal laser procedure is a newer procedure that treats vaginal dryness and incontinence without the need for daily medication or use of a medical device. It works by strengthening and increasing the collagen level in the vaginal tissue that supports the urethra, which will prevent leaking.

Several studies have shown vaginal laser treatment to be effective at treating stress urinary incontinence. The benefit of laser is that it is done in 3 simple treatments, no need for nightly medicine, and is a good option for women who don’t want or can’t use hormones.

11. High Intensity Focused Electromagnetic Field (HIFEM) Therapy

HIFEM is a relatively new technology that has been cleared by the FDA for treatment of urinary incontinence. This procedure uses an electromagnetic field to contract and relax the pelvic floor musculature for you while you sit on a chair. The contractions are consistently stronger than most women can do on their own and up to 11,000 contractions can be done in 28 minutes. This may be an excellent choice if other treatments haven’t helped or you are searching for a more immediate solution. The treatment is done in the doctor’s office and is noninvasive, meaning you stay fully clothed and there are no internal exams.

Surgery

If all else fails, there are a variety of surgical procedures designed to treat stress incontinence. Slings and suspension  procedures are two of the most common surgical ways to treat stress incontinence.

12. Sling procedures

Sling procedures use either your own tissue or a synthetic mesh to create a “hammock” under the urethra or the bladder neck to support them.  The sling keeps the urethra closed with anything that increases pressure in the abdominopelvic cavity like cough or sneeze. There are a variety of different types of sling procedures.  You and your surgeon can discuss which one might be best for you.

13. Suspension procedures

A bladder neck suspension is another type of surgery that can be done to treat stress urinary incontinence.  This procedure uses stitches to support the urethra and bladder. The sutures lift the bladder and secure the urethra to nearby structures like the pelvic bone thereby helping to prevent urinary leakage.

There’s no need to suffer any more!

Stress urinary incontinence is common, but can also be embarrassing and uncomfortable. Fortunately, there are many treatments available to help solve this issue. So go ahead, jump on that trampoline!

Dr. Becky Kaufman Lynn is a gynecologist and the founder of the Evora Women’s Health. She is a North American Menopause Society Certified Physician who has been treating menopausal women for over 20 years. Her practice is located in St. Louis, Missouri. Dr. Lynn offers a comprehensive midlife wellness program helping women lead healthy lives. Go to evorawomen.com for more information about her practice or to schedule an appointment or send us an email at info@evorawomen.com. Dr. Lynn offers telehealth visits in illinois and Tennessee.