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Treatments offer relief from stress incontinence: most treatments for urine leakage are effective, minimally invasive, and can eliminate embarrassment and worry.

Stress incontinence--urine leakage that occurs when a person laughs, coughs, sneezes, or exercises--is experienced occasionally by about 50 percent of women; almost 20 percent of women over age 75 have it daily. Although stress incontinence rarely causes other medical problems, it can interfere with daily life--some women avoid leaving their homes due to worry about leakage.

If you're restricting your activities due to stress incontinence, report your symptoms to your doctor. Treatment advances have resulted in a higher success rate, lower risks, and shorter recovery times.

"Stress incontinence is treated rather easily, and the cure rate is high," says Jennifer T. Anger, M.D, assistant professor of urology at UCLA. "With appropriate treatment, a woman can greatly improve her quality of life."

Contributing factors. Stress incontinence occurs due to weakness in the muscles in the pelvic floor that support the bladder--the organ that stores urine--and the urethra--the tube that carries urine from the bladder to the outside of the body. When you cough, laugh, or sneeze, extra pressure is placed on the bladder, and the muscles aren't strong enough to retain urine in the bladder.

The biggest risk factor for stress incontinence is vaginal delivery, according to Dr. Anger. Number of deliveries and length of labor also are factors. Other conditions that raise your risk are obesity, smoking, and chronic bronchitis. Extra weight, as well as frequent coughing, puts more pressure on the pelvic muscles. Aging is also a factor. "After a woman goes through menopause, the tissues in the pelvic area get weaker, and this creates a predisposition to stress incontinence," says Dr. Anger.

Treatment options. Most women begin treatment by doing Kegel (pronounced KAY-gul) exercises that strengthen the muscles in the pelvic floor. "These are the same muscles a woman uses to stop and start her urinary stream," explains Dr. Anger. "Once you strengthen these muscles, you can squeeze them when you cough, laugh, or sneeze to prevent leakage." If you have trouble identifying these muscles, ask your doctor.

Another option, considered minimally invasive, is an injection of a balking agent, such as collagen, into the area around the urethra, which helps the urethra stay closed. However, this procedure is temporary--it lasts only three to six months.



Another option is surgery. According to Dr. Anger, the sling procedure is the most commonly used among urologists. In this procedure, material is inserted through an incision in the vagina, placed under the urethra, and attached on either side. "The sling acts like a hammock under the urethra," explains Dr. Anger. When you cough or laugh, the sling pushes on the urethra and keeps it closed, preventing urine leakage. The sling may be made of fascia--a piece of tissue taken from the woman's abdominal area--or it may be made of synthetic material, such as polypropylene mesh or a mesh-like tape.

"The newer sling techniques are less invasive. They often take less than 30 minutes, and the patient usually is able to return home the same day," says Dr. Anger.

Another procedure is called the Burch colposuspension, in which tissue under the urethra is attached to a ligament by the pubic bone.

Diagnosis. Stress incontinence is confirmed if the patient has urine leakage when she has a full bladder and coughs. Tests to rule out an infection in the urinary tract are also conducted. "We also do a pelvic exam to find out if the woman's bladder has fallen. This is known as a prolapsed bladder, or a cystocele," says Dr. Anger. A cystocele is treated by lifting the bladder and/or the vagina at the same time as the sling procedure is performed.

Bladder pressure testing may be done to check if urge incontinence--the inability to hold your urine long enough to reach the toilet--is also occurring, Dr. Anger says that 40 percent of women have mixed stress and urge incontinence, and both types must be treated for a successful outcome. (For urge incontinence, anticholinergic and antispasmodic medications can help stop involuntary bladder contraction by relaxing the bladder muscles. In severe cases, reconstructive surgery may be performed.)

If stress incontinence is affecting your quality of life, don't let embarrassment stop you from seeking help. "It's better to be treated sooner than later, so you can stay dry and have a better quality of life," says Dr. Anger.


* Practice Kegel exercises for 10-second intervals 10 times in a row two or three times each day.

* Determine if urine leakage occurs only when you laugh, cough, or sneeze (signs of stress incontinence).

* If you have had prior treatment but your symptoms return, talk to your doctor about a second procedure.
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Title Annotation:WOMEN'S HEALTH
Publication:Healthy Years
Date:Jun 1, 2008
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