Stress Incontinence

I am a 56 year old woman and every time I cough or sneeze, I leak urine. It's gotten so bad that I need to wear pads nearly all the time. I'm so embarrassed--is there anything I can do?

Many women feel isolated and embarrassed because of urinary incontinence. The problem is a silent plague--it is extremely common but no one ever talks about it. There are two major types of urinary incontinence in women: stress and urge. Stress incontinence is characterized by the leakage of urine with increases in intraabdominal pressure (like coughing, sneezing, or exercising). Risk factors include older age, obesity, childbirth (especially forceps delivery), and chronic cough or constipation.

The continence mechanism in women is complex--connective tissue supports which hold the bladder in place, a muscular sphincter around the urethra, and special types of nerve fibers all play a role. Trauma to parts of this system, often related to childbirth, can lead to incontinence. Sometimes this remains stable over time with loss of urine only during vigorous cough with a full bladder. Often it is a minor nuisance for women during their 30s and 40s with distressing evolution to chronic pad-wearing and clothing changes in their 50s and 60s.

What can women do? First, if you are bothered by stress incontinence, do not accept the situation as "part of getting older"! For women who are minimally bothered with symptoms while exercising, use of a lubricated tampon inserted just before exertion can sometimes dramatically reduce leakage. In women with more severe or constant incontinence, the starting point is a history and physical examination with a gynecologist or urologist. Non-surgical therapies include physical therapy and/or biofeedback and/or medications. Surgeries include Burch colposuspension (an abdominal surgery) and Monarc or tension-free vaginal tape (TVT) placement. The latter two are both vaginal surgeries and allow a much more rapid recovery; most women are out of the hospital the same day or within 24 hours.

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