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Q: Is there anything I can do for my urinary incontinence other than surgery?
A: Surgery may not be necessary or appropriate to correct urinary incontinence. There are many “self-help” techniques that have proven to be effective.
Urinary leakage or urinary incontinence is a common problem, but often not discussed because of embarrassment. As many as 20 percent of woman by age 40 have some degree of unwanted leakage. Although there are many causes of urinary incontinence, the two most common causes are stress incontinence (cough-leak) and urge incontinence (“gotta go” but can’t make it).
Fortunately both stress and urge incontinence can be improved by strengthening the pelvic floor muscles surrounding the urethra, the so-called “Kegal contractions”.
Many women have tried Kegals but frustrated by lack of success possibly because the pelvic contractions are not effective. Not all women can do Kegal contractions. Try as they might, there is just no connection. The ability to stop flow mid-stream is one indication of an effective Kegal.
The next step is to establish a training schedule until it becomes habit. A common technique is to perform five to ten 5-sec contractions while waiting for the light to change on the way to work.
The exercises will improve the resting tone of the pelvic floor muscles minimizing the unexpected leakage. In addition, if leakage can be anticipated, the contraction can be maintained throughout the activity, for example, performing the Kegal while swinging a golf club. Multiple short Kegal contractions can also be used to suppress urgency. Contraction around the urethra causes reflexive relaxation of the bladder decreasing the urge to void.
Other self-help techniques include bladder questionnaires, bladder diaries, timed voiding and bladder diet. The addition of medications is helpful for managing urge incontinence. Finally, if surgery is necessary for stress incontinence, it is a brief outpatient procedure with high success, brief recovery and few complications.
Donald Rubino, MD, FACOG, is a board-certified obstetrician and gynecologist at Newton Medical Center.