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Six months after moving into our new house, our basement flooded with six inches of water. It was a huge household disaster, but it was nothing compared to a small leak that had been disrupting our family life for five years.
Ever since the birth of my first child, a 9-pound baby boy, I had dealt with stress urinary incontinence. My obstetrician and pregnancy books covered diastasis rectis, stretch marks and hemorrhoids but didn't discuss stress urinary incontinence. Of course, my doctor encouraged me to do Kegels before and after pregnancy, but I learned those Kegels couldn't help me.
On a warm spring day when my baby was 4 months old, I went outside for some exercise. I started leaking urine, and I just couldn't stop it. I finished every run with soaked underwear and shorts. I leaked when I coughed, laughed, sneezed or lifted things at work and at home.
Over the next five years, I had two more healthy, heavy children, and I kept doing those Kegels. And I kept leaking.
Stress urinary incontinence (SUI) affects at least 15 million women and one-third of those women are suffering enough to limit their daily activities. I needed to wear a pad to get through the ordinary day. I stopped enjoying life as a mother and a woman. I cut back on running, playing with my children, and I didn't feel free to be intimate with my husband. I held back at work and avoided leading workshops or activities, because I was worried about my leaking. I didn't dance at weddings, and I hated shopping and trying on clothes. I was afraid to laugh. Sometimes, I barely even laughed.
Weakness in pelvic floor muscles or in the sphincter, a muscle around the opening of the bladder, can lead to SUI.
But after the birth of my third child, I knew I needed to fix my SUI. I explored a few different treatments and learned my incontinence was a mechanical problem. A urologist performed outpatient surgery and put a sling in place, which kept my urethra in a normal position so my bladder didn't leak anymore. Over the next six months, my confidence came out of hibernation and I regained my life.
Stress urinary incontinence is most often the result of pelvic floor muscle weakness, which is why Kegels are so important. Weakness in pelvic floor muscles or in the sphincter, a muscle around the opening of the bladder, can lead to SUI.
Another cause of SUI is pelvic prolapse, which happens when the bladder, urethra or rectum slip out of position into a woman's vagina. Vaginal childbirth sometimes causes nerve and tissue damage in the pelvic region, and this can lead to pelvic prolapse.
Women of all ages experience stress urinary incontinence but not many know what their options are. Whatever the cause of SUI, it's important to know that there are options for treatment. Right now, women can explore behavior changes, medicine, pelvic floor muscle training and surgery.
Photograph by Twenty20
Behavior changes are a non-surgical, non-pharmacological way to manage SUI and include drinking less fluid, especially alcohol and caffeinated beverages, going to the bathroom frequently and avoiding running or jumping. You can also increase your fiber intake to reduce constipation, which can worsen your SUI. Quitting smoking and getting to a healthy weight are also recommended. Other suggestions are to avoid spicy foods, citrus foods and carbonated beverages.
Some studies have shown that eating magnesium and getting enough vitamin D reduce urine leakage.
Kegels and other physical therapy are both effective, non-surgical treatments, but only for certain kinds of SUI. Kegels, the first line of defense, are easy to learn and easy to do anywhere, anytime. Physical therapists trained to treat SUI can help with additional exercises and therapies like biofeedback, which helps women identify and control their pelvic floor muscles. Using a vaginal cone, which is inserted into the vagina and held in place by tightening vaginal muscles, is another way to to build up muscle strength and tone.
Fixing that small leak led to big changes.
Drugs are also available, but they are really more for the treatment of urge incontinence (feeling like you need to go) rather than stress incontinence. There are three main categories of medicine. Anticholengics block nervous system signals to bladder muscles and include oxybutynin, tolterodine, darifenacin, trospium and solifenacin. Antimuscarinic drugs block bladder contractions, and beta agonist-mirabegron enhances bladder relaxation.
It's very important to note that these drugs all have potential side effects, like dry mouth and constipation, while others can cause nervousness, headaches and high blood pressure.
Then, there is surgery.
For some types of SUI, medicines and exercises won't work and surgery is the only way to alleviate the leaking. That was definitely the case for me. Tension-free vaginal tape and vaginal slings lift and hold the urethra in the correct position and stop leaks. Surgery is the only way to repair weak vaginal walls in cases of prolapse. Other surgical options include putting in artificial sphincters to prevent leaking. Some women choose bulking injections that create a thicker area around the urethra, but this procedure needs to be repeated in a few months or years.
Some people feel hypnotherapy and acupuncture may also help, but there isn't a lot of evidence or research on these two methods.
Surgery was the right choice for me. Fixing that small leak led to big changes. Family life is fun again. I've gone back to running—even expanding to triathlons. My professional confidence has also returned, and I finally fulfilled a dream to start my own business.
Surgery isn't necessary for everyone. And kegels don't always fix everything. But what women need to know is that they're not alone. And they don't have to live with the effects of this really, well, draining condition.