Women's Bodies, Women's Wisdom (70 page)

There are a number of types of incontinence. Stress urinary incon tinence (SUI) is the most common one, and the one I will be addressing here. SUI occurs whenever you increase your intra-abdominal pressure so much (by coughing, sneezing, or laughing) that your urethral sphinc ter, the muscle that holds the urethra closed, can’t hold back the urine that’s in the bladder.

Common Causes

Common reasons for weakness of the urethral sphincter are the following:

Overall weakness of pelvic floor muscles
Pregnancy (the SUI usually ends after delivery)

Damage from childbirth (this is much less likely to happen when a woman is encouraged to birth in a relaxed, conscious, and fully supported manner; prevention of SUI is not an indication for a C-section)

Genetic factors that result in connective tissue weakness (women with this problem will often have many female relatives with problems related to prolapse of pelvic organs)

Persistent, chronic cough, usually from smoking, which results in repeated chronic intra-abdominal pressure that overrides the strength of the urethral sphincter

Excessive abdominal fat, which increases intra-abdominal pressure

Treatment

Strengthening Your Pelvic Floor

The first line of treatment for SUI is to strengthen and tone your pelvic floor through Kegel exercises. Pelvic floor strengthening should be part of every woman’s health care routine, not only for optimal sexual functioning but also if you have a tendency toward SUI. When your pelvic muscles are strong and flexible, they can better support the urethra so that it doesn’t give out when you do anything that increases intra-abdominal pressure.

Unfortunately, the vast majority of women who are told to do Kegel exercises are not instructed in how to do them properly, and that’s why so many women (and their doctors) don’t think they work. When properly and consistently done, these exercises have been found to help up to 75 percent of women overcome their SUI problems.
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Kegel exercises involve squeezing the pubococcygeus (PC) muscle, the same muscle you use to stop the stream of urine. (See the section on Kegel exercises in chapter 8.)

Kegel exercises will not work if you contract your abdominal, thigh, or buttocks muscles at the same time that you are squeezing the vagi nal area. In fact, this only increases intra-abdominal pressure and aggravates the problem. To make sure you’re doing the exercises correctly, put two fingers in your vagina, spread them apart slightly, and squeeze the vaginal muscles— you should feel the muscles tightening around your fingers. These are the only muscles that should be contracted. To make sure that you don’t contract your abdominal muscles, put your other hand on your lower abdomen as a reminder to keep your belly soft and relaxed. Video-and audiotapes are available to help you learn Kegel exercises properly.

There are other ways to strengthen the pelvic floor muscles besides Kegels. One method, which is based on ancient Chinese techniques, in volves inserting a weighted cone into your vagina and simply holding the cone in place for a few minutes twice a day. (See Resources.) You start with the heaviest cone that you can easily hold in for one minute, work up to five minutes, then gradually move on to the heavier cones, and finally shift to a maintenance program. Holding the cone in the vagina automatically uses and thus strengthens just the right muscles, so you don’t have to think about whether or not you’re doing your Kegel exercises properly. They work well if you have a stress urinary incontinence problem with no other factors present (such as infection, the effects of drugs such as diuretics, or caffeine consumption).

You can also purchase an effective Kegel exerciser called the KegelMaster 2000 on the Internet. (See
www.kegeltoner.com
.) This de vice provides fifteen adjustable resistance levels, so you can increase resistance as your muscles strengthen. I also recommend the Feminine Personal Trainer (FPT), which is a stainless-steel vaginal weight that allows women to greatly strengthen their pelvic floor through resistance training in about ten minutes. It comes with an excellent video and guide. (Available from As We Change; 800-203-5584;
www.aswechange.com
.) To achieve optimal results in strengthening and healing your pelvic floor, I strongly recommend working with a physical therapist fully trained in pelvic floor rehabilitation.

Though strengthening the pelvic floor won’t cure every type of urinary incontinence, it is always worth a try before resorting to surgery or drugs. Developing a strong pelvic floor not only helps prevent or cure urinary stress incontinence but also increases the blood supply to your pelvis, making you more resistant to diseases such as urinary tract infections. It also enhances the ability to reach orgasm and improves vaginal lubrication during sex. You can do these exercises anytime and anyplace if you’re doing them properly, and not a soul will know. You have nothing to lose, and a lot to gain.

Nutritional Aspects

Many women have stress incontinence only when their urine output is increased, especially from drinking coffee or tea. Even decaf coffee is a diuretic— and so is cold weather (I never drink a cup of coffee in the morning if I’m going skiing, otherwise I’ll have to go back to the lodge after every other run). Many women also have in creased urinary output on the first day of their period, because they’re getting rid of all that premenstrual fluid. Under those conditions, urinary stress incontinence will always be worse because your bladder is always fuller. And coffee is also a bladder irritant. I’ve “cured” several cases of SUI just by telling the patient to stop drinking coffee! It is also helpful to lose excess body fat. (See
chapter 17
.)

Hormones

Some women begin to experience urinary stress incontinence after menopause for hormonal reasons and for the same reason that they sometimes experience UTIs—thinning of the estrogen-sensitive outer third of the urethra. (See section on hormones and UTIs.) If this describes your situation, all you need to do to restore the urethral tissue and regain urinary control is to use a small dab of estrogen cream daily for a week and then once or twice per week thereafter. I prescribe estriol 0.5 mg cream, as opposed to other types of estrogen cream such as Premarin, for this purpose because this type of estrogen works very well locally and has a very weak systemic effect. This means that you can safely use estriol vaginal cream to help restore your vaginal and urethral tissues even if you’ve had breast cancer or another estrogensensitive cancer. Estriol vaginal cream is available by prescription from any formulary pharmacy that carries natural hormones. (See Resources for how to locate a formulary pharmacy.) The usual dose is 1 gram (one-quarter teaspoon) once daily for one week, then two or three times a week as needed thereafter.

Pessaries and Urinary Control Inserts

For mild stress incontinence, simply wearing a menstrual tampon is often helpful because they push on the vaginal wall, compressing the urethra. In one study, 86 percent of women with mild SUI stayed dry during exercise when using tampons, although only 29 percent of women with severe incontinence were helped. If you use tampons for this purpose, remember that they must be changed regularly to avoid toxic shock; don’t leave the same tampon in all day long.

Pessaries, plastic or rubber devices that are inserted into the vagina to help women with uterine prolapse, can also be used successfully for those with SUI. Unfortunately, many doctors have never been trained in their use and therefore patients may not be offered this option.

Specially designed “incontinence pessaries” lift the bladder neck and restore the proper bladder angle so continence is restored while it is in place. They work very well for women who aren’t candidates for surgery, who have an incontinence problem only intermittently, or who have failed to get help from surgery.
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A new prescription product called FemSoft Insert (by Rochester Medical Products) is a silicone tube inserted into the urethra and surrounded by a liquid-filled sleeve. The sleeve creates a seal at the neck of the bladder, preventing leakage. It must be replaced after urination. (For more information, contact Rochester Medical at 800-615–2364, 507-533-9600, or visit
www.1800femsoft.com
.)