Two years ago, Jill Vierregger of Omaha noticed that she was losing urine when she coughed or sneezed. As a retail manager, she meets the public and the leakage was a constant concern. She began wearing a pad for protection.
It was no coincidence that the urinary problems began after she gave birth to an 8-pound baby boy. Though there are other causes, pregnancy is one of the major reasons why stress urinary incontinence occurs in women.
Pressure on a weakened bladder from coughing, sneezing or laughing causes leakage that typically becomes a chronic problem as a woman ages. Incontinence in young mothers is more likely temporary.
“If you cough, you tighten your abdominal muscles, which puts pressure downward on your bladder. It also can happen with exercise, jogging, jumping,” said Dr. Sylvia J. Ziegenbein of the University of Nebraska Medical Center's department of obstetrics and gynecology.
Vierregger first tried Kegel exercises, which are intended to strengthen pelvic floor muscles. The exercises didn't work. Then she moved on to a pessary, a ring inserted into the vagina intended to support the weakened bladder and stop leakage.
“Pessaries are usually the second step behind Kegel exercises,” Ziegenbein said. “Pessaries are probably 60 percent to 70 percent effective in stopping leakage.”
But not for Vierregger. The problem continued. That's when she and Ziegenbein moved on to the next step, an outpatient surgical procedure called a mid-urethral sling. A single strip of synthetic mesh is placed under the urethra to act as support.
“So when we cough or sneeze, the urethra pushes against the sling, and we don't leak,” Ziegenbein said. “Of the women I see for stress urinary incontinence, about 60 percent to 70 percent will eventually have the mid-urethral sling placed.”
The surgery is simple and 90 percent effective at keeping a woman dry, Ziegenbein said.
Complications are rare, according to Ziegenbein. The sling has a 1 percent or less erosion rate (where the mesh erodes into the vagina or bladder). Another possible complication is when the bladder is poked with a needle by the surgeon. “That happens in about 5 percent to 8 percent of cases and, with treatment, heals in five to seven days,” she said.
Vierregger had the 20-minute procedure in January. After the surgery, her problem dried up.
She no longer wears a pad to catch leakage if she sneezes or coughs. “And I no longer have to cross my legs when I sneeze,” she said.
“My self-confidence is so much better. I don't feel as if I'm aging,” said the 43-year-old mother of two with husband Mark.
As she told people about her upcoming procedure, they often responded that they also had the leakage problem. “And I said, ‘Why are you living with that?' They just accept it.”
Stress incontinence affects lives.
“Some women are fearful about leaving the house. They need a job, but don't want to risk embarrassment during an interview. They wonder if others notice an odor. They‘re prisoners in their home,” Ziegenbein said. “Incontinence is a reason some elderly ladies end up in nursing homes.”
She said only a small percentage of women with stress urinary incontinence seek help. “They think it's a process of aging,” Ziegenbein said. “Their mom had to deal with it, so they'll deal with it. Older procedures for stress incontinence weren't effective.”
The bottom line?
“If you're an older woman who has been pregnant at some time during your life, you have a good chance of having stress urinary incontinence,” Ziegenbein said. “But despite what you've heard, you don't have to live with it. There are cures.”
Omaha-based writer Judy Horan is a regular contributor to LiveWell the Magazine.