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Knowledge is power – Know your options – Get back in the game

April 17, 2017 | Dr. Ray Bologna

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When women find out what I do every day, they just want to talk to me about their bladders. Over the past few weeks, this has happened to me on the tennis court, in the hospital, and at a party. All the stories were similar, I leak when I cough, sneeze, lift, exercise, play with my children and I just don’t want to worry about it anymore. A number of these women are in health care and they were surprised there are so many options.

Please help us get the word out, share our website with your family and friends, there are options, and women need to know.
What are the options for stress urinary incontinence – leakage when you cough, sneeze, lift, laugh, or jump?

Stress incontinence results from a loss of support around the tube you urinate through (the urethra). Commonly, these support structures are damaged with a vaginal delivery, pelvic changes with pregnancy, and sometimes it just happens with time. All of the treatment options are directed at improving the support around and under the urethra.

1. Pelvic Floor Therapy – Kegel exercises (i.e. pelvic floor strengthening) can improve the strength around the urethra. Learning to engage your pelvic floor when you cough can help prevent leakage. Pelvic floor therapy can be done on your own or with a physical therapist dedicated to pelvic floor therapy. Pelvic floor therapy with a physical therapist is often covered by insurance.

2. Nonsurgical devices that are placed in the vagina and put pressure on the urethra.

  • Pessary – These devices are simply fit in the office. Some women use them when exercising; others leave them in all day. A pessary does need to come out on a regular basis and be rinsed off and placed back in. Most women can easily remove and replace it themselves. It must come out for intercourse. Pessaries are covered by insurance.
  • Poise Impressa®  – A disposable device that is placed in the vagina like a tampon and pushes up on the urethra to provide support. You need to purchase the sizing kit to determine which size is right for you. I have had a number of women try this product and it can help.

3. The most common surgical option is a sling. Slings can be made from a synthetic material or from your own tissue. Commonly, synthetic slings are used because they are the least invasive. The use of synthetic slings or mesh has been approved by the FDA for over 20 years. A sling is just over 1 cm wide and has a wide weave. Your tissues grow in and around the material. There is a small percentage of women who do not heal over the mesh and that requires a procedure to remove that edge of mesh either in the office or the operating room. Slings are done as an outpatient; they can be done under a general anesthetic or with just sedation. Many patients can go back to work in 2-3 days as long as they do not have to lift at work. Typically, a patient is asked not to do any heavy lifting, pushing, or pulling for 4 weeks. Slings have a 95% dry or improved success rate. You should make sure your questions are answered about slings and you are comfortable with the procedure prior to having surgery.
I love talking about bladders regardless of the venue – parties, tennis court, or hospital hallways.
Help us spread the word. Tell your friends and family.
Please know these options are available. Do the things you want to do without worrying about leaking.

Find more articles on Bladder Problems, Stress Incontinence