Stress incontinence

Q: Since going through menopause three to four years ago, I’ve had a problem with what I believe is called stress incontinence–bladder leakage during exercise, etc. It’s not a huge amount, but enough to be a real inconvenience as I know the importance of staying active. What are my options? I refuse to accept this as just a part of getting older.

A: Genuine stress incontinence (loss of urine while coughing or physically active) is the result of increased bladder pressure and decreased urethral resistance. The most common cause is pelvic floor relaxation, which is most often seen in Caucasian women who have had vaginal deliveries. Other causes of this pressure differential between the bladder and urethra are also possible–e.g., abdominal tumors and chronic pulmonary disease.

If the problem is not greater than what is called a first degree cystocele (determined by a medical exam), a good response can be seen with Kegel exercises. Kegel exercises are simple: Just contract the pelvic floor muscles and tighten the anal sphincter.

The easiest way to learn Kegels is to practice shutting off the flow of urine in midstream. Once you know what this feels like, you can contract those muscles anytime, anywhere. Hold the contraction for five to 10 seconds, and repeat a minimum of five to 10 times per day. Although Kegel exercises alone are less effective in postmenopausal women, Kegels with hormone replacement therapy (the preference here would be the use of natural estrogens, natural progesterone and/or herbs) are quite effective. It’s definitely worth trying. For guidance, try to find a gynecologist who’s familiar with herbal and natural hormones for menopause, or a naturopathic physician knowledgeable in women’s health.

If the combination of Kegels and hormone replacement doesn’t work for you, your other option is surgery. The long-term surgical correction rate for stress incontinence is approximately 70 percent.

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