Earlier this month, we talked with Dr. Angel Marie Johnson, the director of our Women's Health Center in Dedham, about overactive bladder in women. Today, Dr. Johnson addresses another common condition that plagues women: stress urinary incontinence.
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Q: What is stress urinary incontinence in women?
Dr. Johnson: This is when women leak urine with activity. They have a sudden cough or sneeze, they go for a jog, they do a jumping jack, and they leak urine.
And this is even more common than overactive bladder because it happens to many younger women following childbirth. Yet many of these women think, 'Oh, everybody leaks a little bit when they jog.' And then I explain to them that this isn't normal. Outside of potty training, you are not supposed to have accidents with urine.
It's one thing to be aware that it's not normal and to decide to live with it; that's okay because it's the patient's choice. But it's another thing to not even know that leaking urine with activity is abnormal—and to not even know that there are physicians out there like myself who can provide other options, both surgical and non-surgical.
I invite people to watch the women's health education seminar I gave in May 2018. It's all about urinary leakage as well as other conditions. [Editor's note: scroll to the end of the article.]
Q: So stress urinary incontinence is different from overactive bladder?
Dr. Johnson: Yes. People often confuse stress incontinence with overactive bladder—they're entirely different conditions. Overactive bladder involves frequent urination, sudden urgency to go, and/or getting up multiples times a night to urinate (nocturia). Stress urinary incontinence involves leakage with activity, like a cough, laugh, sneeze, or exercise.
Overactive bladder is a problem with the function of the muscle (the bladder). Stress urinary incontinence is a structural problem. So while medications can work on overactive bladder conditions, medications don't work on stress urinary incontinence, because meds can't affect or influence structural issues.
Q: So what are the treatment options for stress urinary incontinence?
Dr. Johnson: So, again: medication does not work on structure. Surgery restores structure. So for the people who leak with a cough, laugh, or sneeze, we either do surgery—a sling, which involves gynecological mesh. This is still the number one recommended treatment for stress urinary incontinence. Or we work towards strengthening the structure itself through Kegels or pelvic floor exercises. Because stress urinary incontinence can be due to muscle weakness, we can work on strengthening those muscles. That's what the Kegels and/or pelvic floor exercises do.
Pelvic floor physical therapists can be especially helpful with the latter. They are physical therapists who finished physical therapy school and then do a fellowship—essentially subspecialty training in women's health and pelvic floor disorders. And they can work with these women specifically to improve their bladder function. This work is typically covered by insurance, and there's no downside because there are no side effects. It's not surgery; it's just strengthening your muscles.
Q: Any final thoughts you want to share?
Dr. Johnson: Yes. If you're suffering from stress urinary incontinence—especially to the point that you stop living your life fully, like maybe you stop playing with your kids outside or you avoid taking part in a workout class—seek help. Your quality of life matters. And there are treatment options. Get your life back and make an appointment.
Thanks, Dr. Johnson!
Watch Dr. Johnson present a women's health education seminar where she discusses stress urinary incontinence and other pelvic floor disorders in more detail.