By: Dr. Howard Goldstein, Dr. Babak Vakili and Dr. Emily Saks

Do you have to brace yourself when you cough?

Are you holding back your laughter on that really funny joke? Do you avoid pushing your limits when you exercise because of a fear of leakage? Do you dread those coughing spells? If so then you may have stress urinary incontinence.

Stress incontinence is leakage that happens when the bladder is stressed.

The “stress” in stress incontinence is not the psychological kind, but a physical problem.  Triggers for leakage may include coughing, laughing, sneezing or exercise.

Stress incontinence is not actually a bladder problem.

Instead, it is a problem with the urethra – the short tube that drains the bladder to the outside. The urethra also serves to prevent involuntary emptying of the bladder when it fills. There are two elements of how the urethra functions that allows it to do this.

The first is the support elements of the urethra – the ligaments that help anchor the urethra to the pubic bone and the vagina underneath the urethra that provides a stable backboard. If these ligaments become damaged or the vagina becomes more elastic, the urethra can sag in response to stress, leading to incontinence.

The second element is the muscular sphincter, the muscular portion that squeezes tight to prevent loss of urine with increases in pressure. Injuries or damage to this muscular area can also lead to stress incontinence.

Stress incontinence is most commonly the result of a combination of
support defects and diminished sphincter function.

Although stress incontinence can affect as many as 50 percent of women by the age of 50, it can start as early as one’s teenage years. Genetics plays a strong role in the development of stress incontinence even though no specific gene has ben identified. Other acquired factors such as child birth, aging, menopause, chronic straining or hysterectomy can contribute to developing stress incontinence. Because of the genetic component, it is possible that one may have very few acquired factors and still develop stress incontinence.

Treatments for stress incontinence have excellent results.

Guided Kegel exercises – pelvic area exercises that strengthen the muscles of the pelvic floor – can yield improvements in as many as 80 percent of women. Surgery for incontinence has evolved greatly over the last two decades from procedures that were invasive and not terribly durable to the current suburethral sling procedures.

The suburethral sling surgery is a minimally invasive outpatient surgery that offers outstanding and durable results. It requires a mild amount of sedation, a small (1 cm) vaginal incision for placement and takes about 20 minutes to perform. Success rates can reach as high as 95 percent. There is little down time afterwards with patients returning to normal activity within one week.

These “Mini-slings” have been performed in various forms since 1997 and have stood the test of time. There are now numerous mild modifications that may or may not have specific advantages for you. Our thorough evaluation process will allow us to choose the proper technique to optimize your results.

If you find that stress incontinence is impeding you from doing the things
you truly enjoy, such as jumping on a trampoline,
going full speed on a hard workout
or even partaking in good-natured fun, then come and talk to a specialist.

You will have a thorough evaluation and explanation of your options. Being dry can be a 20 minute procedure away.

Babak Vakili, M.D. is the director of the Center for Urogynecology and Pelvic Surgery. Dr. Vakili is a fellow of the American College of Obstetrics and Gynecology. He completed a fellowship in Female Pelvic Medicine and Reconstructive Surgery at the Louisiana State University Health Science Center in New Orleans, LA.

Howard B. Goldstein, D.O., MPH, is a fellow of the American College of Obstetrics and Gynecology. He completed a fellowship in Female Pelvic Medicine and Reconstructive Surgery at Cooper University Hospital in Camden, N.J. He currently serves as the Director of Research and Education for the Division of Urogynecology.

Emily K. Saks, M.D., MSCE, is a urogynecologist with the Christiana Care Center for Urogynecology and Pelvic Surgery. Dr. Saks completed a residency in Obstetrics and Gynecology at Pennsylvania Hospital in Philadelphia and has completed a fellowship in Female Pelvic Medicine and Reconstructive Surgery at the Hospital of the University of Pennsylvania.

The Christiana Care Center for Urogynecology and Pelvic Surgery is located in Suite 1208 of Medical Arts Pavilion 2, on the campus of Christiana Hospital in Newark. Appointments are also available at the Christiana Care Center for Women’s Health, 3706 Kennett Pike in Greenville. For more information or to schedule an appointment, call 302-623-4055 or visit www.christianacare.org/urogynecology.