Laughing, Coughing, Sneezing, Peeing?

By: Dr. Allison Keen

It was the day after Christmas.  I was at my mother in law’s house with my husband and 2 month old baby.  I finally had a moment to go for my first run since giving birth to my son.  I bundled up and headed outside only to be devastated by what happened.  I was not even a half a mile into my run and I started leaking urine.  By the end of the run, I was in tears.  I had leaked through my clothes and ran to the shower when I got back to the house.  

I immediately began doing daily Kegel’s, a pelvic floor exercise. “That will take care of it” the gynecologist in me told myself.  Despite my dedication to pelvic floor exercises, I continued to leak.  

I would joke when I had to cross my legs to cough or sneeze,   I chose not to chase my kids in the yard or play tag with them for fear of leaking through my clothes.  I stopped running for awhile because of the shame of wearing a poise pad.  After a 13 year investment in pads for daily use and workouts, I finally talked to my doctor about my symptoms.  

As a gynecologist and a woman who has suffered years from stress urinary incontinence, I have realized that many women don’t mention it to their doctors. Many feel that it is just something that happens after we have kids or as we age, but leaking is not something we have to just accept.

What is Stress Urinary Incontinence (SUI)?

SUI is a type of bladder leakage that occurs with “stress” to the pelvic floor. Examples of stress might be laughing, coughing, sneezing, jumping and running. Leaking can occur with sex and orgasm, and in severe cases even with walking or other more gentle movements.  SUI is different from urge urinary incontinence, which is feeling a sudden urge to find a bathroom immediately. Some women have symptoms that are mixed stress and urge incontinence as well.

What are the causes of SUI?

SUI is caused by a weakening of the muscles and supportive tissue that surround the urethra. Without proper support, the urethra becomes hypermobile and doesn’t close with increases in intra-abdominal pressure. This allows urine to leak involuntarily. SUI is more common with increasing numbers of vaginal deliveries, as well as deliveries assisted by forceps. Increasing age, obesity and family history are also risk factors.

What can be done about SUI?

Stress incontinence can be treated with lifestyle modifications, exercise regimens and surgical therapies. Weight loss can be effective in reducing leakage for women with obesity. Normalizing fluid intake and managing constipation can also help. Kegel exercises are designed to help strengthen the pelvic floor and can be effective for mild to moderate symptoms. While these can be done solo, pelvic floor physical therapy and biofeedback can be very helpful in learning proper technique. Menopausal patients with SUI may also benefit from vaginal estrogen therapy. Some women choose to use a pessary, a device that is placed in the vagina to limit urethral mobility and leaking. Finally, if conservative measures fail, surgery offers high success rates. The most common surgery is placement of a sling underneath the urethra to provide added support.

I ended up with a surgical treatment in the end, but you may prefer a different approach. Talk to your gynecologist if stress urinary incontinence is an issue in your life. We can help you find the options that are right for you!

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