No Laughing Matter: Stress Urinary Incontinence
By Elizabeth E. Houser, MD
The familiar adage Laughter is the best medicine is true for most people. But for women suffering from the involuntary loss of urine, called urinary incontinence, laughter can be devastating because it can cause embarrassing events such as a urine leakage accident in public. As the baby boomers age, the number of women experiencing stress urinary incontinence (SUI) is increasing dramatically. While the medical, social, financial, and ecological impacts of this disorder are staggering, the real cost is borne by individual women with SUI.
Stress urinary incontinence is the involuntary loss of urine associated with increased abdominal pressure. Coughing, laughing, jumping, and lifting are activities that frequently cause SUI. For some women simple movements such as stepping off a curb result in SUI. Recent studies estimate that more than 18 million women in the United States experience urinary incontinence, with SUI being the most common type. The average time a woman waits to seek treatment for incontinence is seven years, and the cost of pads and adult diaper products can exceed $1,000 annually. The impact on our environment is also significant. Adult incontinence products take up roughly 7 percent of the average landfill—more than double the 2 percent occupied by baby diapers.
Causes of and Risk Factors for SUI
Why does SUI occur? This condition occurs when the pelvic floor muscles, which support the bladder and the urethra, weaken. Without strong pelvic floor muscles, the body is unable to keep urine in the bladder when abdominal pressure increases.
As women age, three factors contribute to progressive weakness of the female pelvic floor muscles. These are the “three Gs”: gravity, gravidy, and gerontology.
The first factor is gravity. Human beings walk upright, and over the years gravity draws all parts of our bodies, including the pelvic floor muscles, downward. The second factor is gravidy, or pregnancy. The weight and the mass of the fetus, whether or not delivered vaginally, place a strain on the pelvic floor muscles. The third factor is gerontology, or aging. As the body ages, tissues, including those in the pelvic region, lose their elasticity and firmness. These three factors combined can result in SUI.
There are multiple risk factors for SUI:
- Chronic cough
- Steroid use
Some of these risk factors can be alleviated by lifestyle changes, but others cannot. Weight management and smoking cessation are examples of risk factors that can be controlled. Although making such lifestyle changes can require some effort, motivated women can achieve results. For instance, stopping smoking can be difficult to achieve alone, but multiple effective methods exist that can support a woman who wishes to quit. With help women with SUI can make the lifestyle changes that will free them from the constant fear of a public leakage accident.
Getting Help for SUI
The good news is that help is available, and therapies for SUI have a high rate of success. The first step is to have an honest discussion with your doctor or other healthcare providers. Realizing that SUI is not normal at any age may help you broach a potentially touchy subject at your next doctor’s appointment. Research shows that the earlier treatment for SUI is started, the more successful the results will be.
At your appointment you can expect your doctor to take a thorough medical history, which will include questions about leakage, fluid intake, exercise patterns, obstetric history, medical problems, prior surgeries, current medications, and drug allergies. A complete physical exam should be performed, including a pelvic exam. This will allow the doctor to assess the position of your pelvic organs and the strength of your pelvic floor muscles. A urinalysis may be performed to rule out infection or blood in the urine. Your doctor may also do a bladder ultrasound to ensure that you are emptying your bladder completely. The ultrasound is important because certain treatments may need to be modified if you do not empty your bladder well.
Once the history and the physical exam are complete, you and your doctor can discuss treatment options, which may include lifestyle changes, conservative therapies, and surgical treatments.
Simple lifestyle changes can make a significant difference in the quality of life for women with SUI. Changes in fluid intake, diet, and exercise patterns are just a few examples.
Don’t drown yourself. Many experts tout the health benefits of drinking large quantities of water, which is definitely necessary for healthy living. At the same time, many “water” products contain caffeine (a bladder irritant) and add calories to your diet. Drink tap or spring water to avoid these issues. The amount you drink in a 24-hour period should be dictated by thirst. What goes in must come out. For women with SUI, drinking excessive amounts of water results in many visits to the bathroom or even leakage accidents.
Avoid bladder irritants. Many foods and beverages can irritate the bladder and tend to increase any kind of urinary incontinence. Some of the most common irritants are caffeine, alcohol, chocolate, citric fruits, and spicy foods. Avoid even decaffeinated coffee and tea, which still contain some caffeine. Sodas with carbonation can also irritate the bladder. When possible, steer clear of these foods and beverages.
Some supplements may also affect the bladder. Vitamin C is a big culprit, as is any medication that lists alcohol as one of the first three ingredients. Read labels carefully before you buy supplements.
Nicotine is another major bladder irritant, and smokers are four times more likely to develop bladder cancer. These are two excellent reasons to kick the nicotine habit.
Weight management. Studies have shown that losing as little as 5 percent of your body weight can significantly decrease leakage episodes. For instance, a 150-pound woman who loses 7 to 8 pounds may experience a significant decrease in SUI symptoms.
Exercise. Most women know that exercise is a key component of most health programs. All too often, however, women want to exercise and lose weight but are unable to because of embarrassing leakage accidents that occur during exercise. This inability to exercise often leads to weight gain, which leads to increased symptoms of SUI, possible depression, and lack of motivation to exercise.
If you have SUI, don’t allow this type of vicious cycle to rule your life. If you want to exercise, use pads or adult diapers as needed and seek help from your doctor. Then get back on your exercise program.
There are many nonsurgical treatments for SUI. Pelvic floor strengthening exercises—known as Kegels—done at home or with a trained therapist have long been known to be effective if done correctly. Unfortunately, many women are never taught to do a correct pelvic floor contraction. Studies show that pelvic floor muscle strengthening has an average cure rate of 73 percent for women with SUI.
Physical therapists may use biofeedback to increase a woman’s awareness of her pelvic muscle contractions; and weighted vaginal cones—yes, you carry them around in your vagina—have also been shown to strengthen the pelvic floor muscles.
Acupuncture has been used for centuries to treat disorders of the pelvis. In select cases this treatment method can provide relief from SUI.
Medications. Currently, no medications are approved specifically for pure SUI. Those women who suffer from a combination of incontinence types, however, may benefit from medication. If you are interested in possible medical treatment, discuss this with your healthcare provider.
Many types of surgeries are available to relieve symptoms of SUI. In recent decades less invasive techniques have allowed shorter operative and recovery times, and many women have benefited from such treatments. Currently, the most common procedure is called the transvaginal tape. There are many variations of this surgery. Most are outpatient procedures that use a synthetic material to reestablish the “normal” anatomic relationship between the urethra/bladder opening and the pelvic floor musculature. Success rates are high, between 85 and 95 percent. In most cases complications are few and minor.
Ignorance is not bliss for women with SUI. Educate yourself about the condition. The Internet is a great source of information about female pelvic health issues. For the first time, women can, in the privacy of their own homes, learn about the options for treatment.
What You Can Do about SUI Right Now
Stress urinary incontinence is a common and very treatable condition in women. As the population continues to age, the personal and societal impacts of SUI will continue to rise. Fortunately, many treatments are available. The first step to getting help is to ask for it. A combination of simple lifestyle changes, such as the loss of a few pounds or avoidance of bladder irritants, may produce a cure in some women. For others, pelvic floor therapy with or without biofeedback and/or acupuncture may do the trick. Still other women will benefit from an outpatient surgical procedure.
If you are coping with the symptoms of SUI, speak up, speak out, and ask for help. There is no reason today to let urinary leakage limit your life experiences. No matter your age, you still have a whole lot of living to do!