You finally set aside time in your way-too-busy life to have a night with friends and it feels great to laugh and enjoy yourself. What doesn’t feel great is a surprise wetness in the panties, just when you’re having fun. But guess what? That leakage is a pretty common occurrence, especially for women. “Stress incontinence is peeing on yourself when you laugh, cough, sneeze or exercise. This is the ‘I laughed so hard I wet my pants’ kind of incontinence. And it’s the one everyone talks about,” says Shilpa Iyer, MD, MPH, an expert in overactive bladder and surgical outcomes with the University of Chicago Medicine. She writes often about sex and health issues for all women at the UChicago Medicine site WomanLab.
“Up to 35% of women have stress incontinence that we know of,” Dr. Iyer says, adding that this number doesn’t include those women who haven’t shared their stress incontinence with their doctors.
If you’re lucky enough to predict when stress incontinence will happen, you can squeeze those pelvic floor muscles and prevent it, she says. Other times, though, you’re caught by surprise.
What causes stress incontinence?
During pregnancy, childbirth, the postpartum period and long after, your body goes through a lot of changes, Dr. Iyer says. But stress incontinence isn’t limited to women who have been pregnant or had a vaginal delivery, she says.
“Aging, weight gain and wear and tear on the pelvic floor causes small injury to the connective tissue that supports the bladder and urethra. When you get a loss of support, the urethra moves more with any abdominal pressure. This leads to leaking with movement, cough, laughing, sneezing and exercise,” she explains. Women are most likely to begin to experience stress continence at ages 45 to 49, and then again after menopause, you may see an increase at 60 to 70.
While stress incontinence itself is difficult to prevent, you can help by “paying attention to your overall health, exercising and eating well,” says Dr. Iyer.
How to make it just go away
The good news about stress incontinence is that there are some treatments that could work for you. Here, Dr. Iyer shares some treatment options and information about how effective they can be:
Learn the Kegel and practice it often. By strengthening your pelvic floor muscles, you can help prevent stress incontinence. “One way to find these muscles is to stop your stream while you are peeing,” she says. “If you can do this, you have found your pelvic floor muscles.” Once you have identified them, you can squeeze and release your pelvic floor muscles to strengthen them.
Or, you can see a pelvic floor physical therapist, who is “like a personal trainer for your pelvic floor,” Dr. Iyer says. “They are trained physical therapists who really understand the pelvic floor muscles and will work with you to help stop the leaking.” Most of these specially trained physical therapists are women, so they’re more likely to understand your anatomy firsthand.
Consider a pessary. A pessary is “a silicone ring with a knob on one end that sits in your vagina and puts pressure on your urethra,” which makes it easier for you to control the flow of urine, Dr. Iyer says. The pessary can be fitted by your gynecologist, or there’s a version that you can purchase from your drugstore. The physician-fitted pessary should be cleaned by you every week, or when you are sexually active. If your physician manages it, it needs to be cleaned every three months, either by you or by your doctor. The DIY version is essentially that: you fit it yourself and dispose after each use. “Both types of pessaries are great options,” Dr. Iyer says.
“Both pelvic floor physical therapy and a pessary can improve symptoms in 50% of women with minimal risk, and cure 15% of women,” Dr. Iyer says.
Surgical options. If neither of these options are right for you, Dr. Iyer says there are many different surgical options, and the best type for you depends on your medical history. “There are two very common surgeries for stress incontinence: urethral bulking and sling procedures,” she says. “Surgery — specifically a midurethral sling — can cure over 90% of women.”
She encourages women who are bothered by stress incontinence to discuss your options with your doctor or see a urogynecologist or urologist because these types of physicians specialize in stress incontinence. The Center for Pelvic Health at UChicago Medicine specializes in the evaluation and medical management of stress incontinence and other pelvic conditions.
“You are not alone if you have stress incontinence,” she says. “When it bothers you, talk about it! We have good treatments that can help you stay out of pads and lead a fuller life!”
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