Welcome back to Prisma Health On Call, our Q+A series that connects you, our readers, to the healthcare professionals at Prisma Health.
This month, we’re tackling a medical condition many women hesitate to talk about — but that many personally experience. That condition is urinary incontinence (and other pelvic floor disorders)
Prisma Health urogynecologists are here to answer reader-submitted urinary incontinence questions — including those about treatment options, medication, pregnancy + more (we even got a question from a male reader).
See the full Q+A below. And big thanks to Hema Brazell, MD, Thomas Mattox, MD, Elizabeth Dray, MD, for their knowledge + expertise.
Q: Should women have incontinence issues for years after childbirth? I feel like this is very common, but not normal.
A: It’s true that urinary incontinence is very common, but not normal — unfortunately, it is “normalized” since it is so common. Childbirth is the biggest risk factor for developing UI. If you have UI that is affecting your quality of life and holding you back from the activities you enjoy, please see your local urogynecologist for treatment options.
Q: What is pelvic floor therapy and why does it help?
A: Trained pelvic floor therapists can help with a wide array of pelvic floor disorders. Pelvic floor therapy addresses issues with the pelvic floor muscles. In patients who have poor coordination or poor tone, improving muscle strength also improves incontinence.
Q: Is tearing during vaginal delivery linked to pelvic floor disorders later in life? Should I consider c-section to avoid my risk of developing pelvic floor disorders?
A: Vaginal delivery confers a higher risk than cesarean delivery for development of pelvic floor disorders. However, cesarean delivery has not been shown to decrease pelvic floor disorders, as women with c-sections can still develop urinary incontinence and pelvic organ prolapse. Moreover, c-sections are considered major surgery and pros/cons of the procedure should be discussed with your obstetrician.
Q: What are signs someone needs pelvic floor physical therapy? What should I look for in a good pelvic floor therapist and why don’t more doctors recommend this as a first line treatment?
A: Anyone can see a pelvic floor therapist. Some women like to see a pelvic floor therapist to strengthen their pelvic floor after pregnancy, for example. Pelvic floor therapists will see and treat a variety of diagnoses. A few examples of what they treat include, but are not limited to, pelvic organ prolapse, urinary incontinence, fecal incontinence (involuntary loss of stool), and pelvic pain. If you are unable to contract your pelvic floor muscles, a pelvic floor therapist is recommended.
Well trained pelvic floor therapists have a pelvic health certification through Herman & Wallace and/or the Academy of Pelvic Health Physical Therapy (APTA). Unfortunately, pelvic health PT is under utilized.
Q: What treatments are available for incontinence?
A: Urinary incontinence (UI) is very common and negatively impacts quality of life for those suffering from it. There are several different types of UI and treatments are individualized depending on the type of UI you suffer from and how bothersome it may be for you. Conservative treatments include Kegel exercises (with or without the help of a pelvic floor physical therapist), medications, a medical device called a pessary, Botox injections into the bladder, nerve stimulators, and surgery.
Q: Short of medication, what can I do to help control urinary incontinence?
A: This depends on the type of urinary incontinence. Not all incontinence is treated with medication. The important thing is to have the correct diagnosis so treatment can be tailored to your specific issue. There are also lifestyle modifications that may help such as losing weight if you’re overweight and monitoring your fluid intake.
Q: I’m a 66-year-old female and wasn’t successful at doing pelvic floor exercises. Now I’m leaking when I sneeze. I’m considering the tac surgery, which I’ve heard is not “easy.” Tell me more about the procedure and recovery please.
A: A mid-urethral sling is the gold standard for surgery for stress urinary incontinence (leaking when you laugh, cough, sneeze). It is a 30-minute outpatient procedure performed vaginally. Recovery is about 2-5 days (mild soreness), but there are lifting and pelvic floor restrictions during the healing period. It is a very effective surgery for the treatment of stress incontinence.
Q: Have you found that Axonics or Yarlap or any of the over-the-counter products work?
A: Over-the-counter products are typically not FDA-approved (but rather “FDA cleared”) for urinary incontinence so we generally do not recommend them.
Q: I recently graduated to the extra-large napkins, changing them several times a day. I’m not interested in surgery. Is there a safe medication to lessen that urge to urinate so often?
A: There are several medication options for urgency leakage. One of the more common types of medication for urgency leakage is called an anticholinergic medication. Unfortunately, there is significant evidence that use of this class of medication is associated with cognitive decline and dementia. There are alternative options which do not pose this risk. It is best to speak with your doctor to determine which medication will work best for you. Medication therapy is most often used when behavioral changes do not work.
Q: For the past 10 years, I often leak a small amount of urine for around 10 minutes after I urinate. Any suggestions?
A: There can be several reasons for this, so it is important to be examined. Assuming you have not had a prior pelvic floor surgery, some of the more common reasons include vaginal prolapse, constipation (this makes it harder to empty the bladder sometimes), and a urethral diverticulum. Try leaning forward when urinating to see if this helps.
Q: Does excess weight contribute to urinary incontinence?
A: Yes. Studies have shown that a 10% reduction in body weight for someone with a BMI >25 can lead to up to a 50% reduction in urinary incontinence.
Q: Is urinary leakage common in males? Are there any non-medical solutions?
A: Up to a third of older men experience urinary incontinence, with >10% reporting daily leakage. Other health conditions, such as diabetes, stroke, pelvic radiation and surgery for prostate enlargement or prostate cancer can increase this risk.
Some conservative interventions for treating leakage include Kegel exercises and pelvic floor therapy, avoiding bladder irritants, and, in severe situations, devices such as a Cunningham clamp, which should only be used under the guidance of a physician. Other interventions include medication, Botox, sacral neuromodulation, male urethral sling, and artificial urinary sphincter. If you’re interested in learning about the full spectrum of treatments for male urinary incontinence, please make an appointment with a urologist to be evaluated.
Are you seeking treatment for urinary incontinence or other pelvic floor conditions? Schedule an appointment with a Prisma Health urogynecologist to explore treatment options.*