Stress incontinence is the most prevalent type of urinary incontinence, occurring in approximately 1 out of every 3 people assigned female at birth (AFAB). This condition causes small amounts of urine to leak out during activities like coughing, laughing or exercising.
Primary care clinicians should recognize stress incontinence and discuss available treatments with patients. A stepped-care approach should begin with nonpharmacological treatments before moving onto medication or surgery if necessary.
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Physical Therapy
Physical therapy is a treatment that can help alleviate or even cure urinary incontinence symptoms. It also has an impact on mental health, social life, sexual life, sleep quality, independence levels and finances.
A skilled physical therapist can identify the underlying causes of your incontinence, such as posture issues, stress and anxiety issues, as well as muscles around your pelvis that impact bladder control. They then create a tailored exercise plan to strengthen these areas so you can better manage symptoms associated with incontinence.
Your therapist may suggest biofeedback, which uses sensors to monitor muscle activity and teach proper use of the pelvic floor muscles. This can be an effective method for strengthening these muscles as well as retraining nerves connecting from your brain to your bladder.
Pelvic floor exercises, commonly referred to as Kegel exercises, can be an effective way to strengthen your pelvic floor muscles and help prevent leaks from occurring. These exercises can be done from home or at a private PT office.
On your initial appointment with your physical therapist, they will assess the extent of your incontinence and what is causing it. Together, you’ll create a plan to improve overall function and wellbeing.
Your therapist may recommend some lifestyle modifications to improve your comfort level and prevent incontinence from starting in the first place. For instance, if you are overweight, they may suggest eating more vegetables, lean proteins and fruits to promote a healthy diet.
They will also suggest a regular schedule of bathroom visits and teach you strategies for dealing with overwhelming urges to urinate. The goal of treatment is to improve your daily functions so that you can lead an enriching and fulfilling life.
In some instances, your therapist may recommend a cystoscopy – which uses a scope to inspect the bladder and urethra – as an appropriate procedure. This procedure can be completed in-office and may even be covered by your insurance.
Pelvic Floor Exercises
The pelvic floor muscles are essential in bladder and bowel control. Situated between the tailbone (coccyx) and pubic bone within the pelvis, they can become weak or injured if not taken care of, leading to urinary incontinence issues in females.
Pelvic floor muscle exercises (PFMEs) are a conservative treatment for stress incontinence that has been scientifically proven to be successful. These exercises strengthen the muscles that support your bladder and urethra – two major vessels responsible for urine flow – so they’re an effective option.
To strengthen your pelvic floor muscles, identify which ones you have and practice these exercises in various positions such as sitting or standing. Aim to do at least five or six sessions each day.
Begin by lying flat on the floor and bending your knees. Keep both feet about hip-width apart while contracting the buttocks and pelvic floor muscles; lift your buttocks off the ground, hold this position for 3-8 seconds, then lower them back down to the floor. Repeat this exercise 10 times.
Once you have finished all the exercises, take a deep breath and relax your body. Next, place one hand on your belly as you gently squeeze the pelvic floor muscles.
If you experience any tightness in your buttocks, thighs or chest while performing these exercises, take a break and take another break. Do the exercises regularly to build stronger muscles and learn how to breathe naturally while performing them.
These exercises can be done anywhere – on the bus, while waiting in line at the supermarket or while talking on the phone. Just don’t raise your eyebrows each time you squeeze!
Pregnancy hormone changes and the weight of your baby can put additional strain on your pelvic floor muscles. Doing pelvic floor exercises during and after childbirth will help strengthen these muscles, reduce stress incontinence, and enhance sexual function.
It is essential that you do these exercises correctly. If you don’t know how or find they don’t work for you, consult your GP for advice or visit a pelvic health physiotherapist who specializes in treating pelvic floor issues.
Vaginal Pessaries
Vaginal pessaries are soft, flexible devices placed inside the vagina to support the bladder, uterus, and/or rectum. They’re often employed as a treatment for stress incontinence in females.
Cystocele or rectocele are conditions where the wall of your bladder or rectum droops into your vagina. While these problems usually have no lasting effects, some people experience symptoms that make living with them difficult.
Your doctor will conduct a physical exam to assess your health status and discuss treatment options with you. They may give you some exercises to do, as well as prescribing medication if needed.
You may also be given a vaginal pessary to wear. These devices come in various sizes, so it’s best to try on several different ones to find the one that fits best.
Once your pessary is working properly, it should be replaced every 4-6 months. To maintain its optimal performance, keep it clean and lubricated with mineral oil.
When your pessary is not in use, you should remove and wash it at least once a week. Otherwise, bacteria could build up leading to an infection known as bacterial vaginosis.
Some people experience allergic reactions to their pessary. If this occurs, inform your healthcare provider immediately so they can switch out the pessary for another one.
Vaginal pessaries can be an effective treatment for stress incontinence. Not only will they reduce leakage, but they may also provide temporary relief when coughing or straining.
Your doctor can fit you for a pessary during an office visit, and within just one day, you’ll have improved symptoms. They will assess the size of the device and show you how to care for it properly.
Once a pessary has been removed for several months, you should be checked for any signs of infection, ulceration or other abnormalities. If you experience pain, discomfort, bleeding, pink or bloody discharge or foul-smelling discharge, contact your doctor right away.
Over-the-Counter Support Devices
Over-the-counter support devices, like urethral shields and bladder patches, can help with urinary incontinence by providing some protection from leaks. They may be used in combination with pelvic floor physical therapy or after surgery.
Some women find that using a disposable, waterproof pad or bladder patch before they urinate helps stop leaks. These items can easily be taken out prior to urination and replaced afterwards for convenience.
Another option is a bladder neck support device, which attaches to the vagina opening and presses against its walls in order to lift and support the urethra. Unfortunately, these devices can be uncomfortable and lead to urinary tract infections if not cleaned thoroughly after each use.
Injectable bulking agents or synthetic polysaccharides may also be utilized to aid in the closure of the urethra. They can be injected into tissue surrounding the upper part of the urethra, but their approval by the FDA must first be obtained for this purpose.
Behavioral therapies are also employed to reduce urine leakage and prevent it from worsening. Usually, these involve altering a woman’s lifestyle so she avoids foods or drinks which have been known to trigger urinary incontinence symptoms.
Kegel exercises, commonly referred to as Kegels, are prescribed to strengthen the pelvic muscles that control bladder and urethra function. Doing these exercises regularly can significantly reduce or eliminate incontinence symptoms.
Some patients with stress incontinence find relief through Kegel exercises. Others are referred to pelvic floor physical therapists for further treatment and management of symptoms.
Other treatments for urinary retention or urgency may involve medications, such as anticholinergics and NSAIDs. If these do not work, surgery may be the next step. A sacral nerve stimulator (SNS) implant sends electrical pulses to the sacral nerve in the lower back which can help with urgent or frequent urination that has not improved after other treatments.
In many cases, a combination of treatments can reduce or eliminate stress incontinence symptoms in females. They also boost a woman’s self-esteem about her bladder and urethra, ultimately improving her quality of life.
