Leaking Down There? Here’s Why — and How to Stop It

By Jennifer Hanes, D.O.

I have noticed that many women with wonderful primary care find themselves too shy to discuss certain medical conditions with their own doctor.  Thus, when I treat them in the Emergency Department, they feel liberated to ask me, a virtual stranger, their embarrassing questions.

One of the most common of these sensitive topics is stress incontinence, also known as urinary leakage.

Although the literature estimates between 30-50% of adult women suffer from this cross-your-legs-before-you-sneeze condition, my experience indicates the incidence may be much higher indeed.  Urinary incontinence — the involuntary loss of urine — may only occur with sneezing or coughing.  However, untreated it can become a significant problem, causing women to alter their routines and social calendars.

The are many categories of urinary incontinence, but the most common is a weakening of the urethral sphincter, the muscle group that controls the flow of urine.  This weakening has several known causes,  including pregnancy and sometimes childbirth.

There are several other causes that can be reversed.  Obesity causes urinary leakage because the extra weight increases the amount of pressure in the abdominal cavity.  The same is true for the chronic cough that frequently accompanies the addiction of smoking.  Another culprit is chronic constipation.  The straining and pushing associated with a low fiber diet create a dramatic rise in pressure in the abdominal cavity.

However, the easiest, and most fun, contributing factor to correct is a weakness of the muscles of the pelvic floor.  The cure is performing Kegel exercises. If you think you know everything about Kegel’s, think again.  Statistically, you have been performing them incorrectly and actually worsened your condition.

Kegel exercises have been shown to help almost three out of four women overcome their stress incontinence, if, and only if, they are performed correctly.  To perform this exercise a woman squeezes her PC (pubococcygeous) muscle which is the muscle used to stop her urine stream.  Millions of women perform this exercise.  So how do you know if you are one of the few doing it correctly?

1) You must ensure you are tightening the correct muscle.  To test, place two fingers into your vagina and feel the pressure as you tighten your PC (imagine you are stopping your stream of urine.)  For the adventurous, invite your partner to help, he can use his fingers to gauge the pressure . . . or not.  Once you are confident you are using the right muscle then start having some fun.  You can ask him to rate on a scale of 1-10 how hard you are squeezing or try to time how long you can hold the squeeze.  You could even try to signal him in Morse Code (a joke, but could be a fun evening.)

2) Most importantly squeeze your PC only.  The common mistakes are contracting abdominal muscles or holding your breath.  If you have any sensation of bearing down (like childbirth or a bowel movement) you are causing more of a problem in the future due to the increase in pressure.  Stop immediately.  Focus on relaxing your entire body except for your PC muscle.

3) Repetition is the key to success.  At a minimum, perform these exercises at least three times per day.  During each interval contract your PC for ten seconds, then release for three.  Repeat five times.  The exact numbers are not as important as remembering to do these frequently.  To help remind you of your new activity,  pick something in your day that can become a memory key.  Some women extend their time in the ladies room for an extra minute or two.   Other women have found stop lights become much shorter if practicing Kegel’s while stuck in traffic.  Other cues could be performing Kegel exercises while brushing your teeth or washing your face.  The correct time is one you will remember every day.

Although seemingly simple, these effective exercises can produce dramatic results in just one or two months.  If your symptoms have not resolved in that time, seek the care of your primary physician.  In severe cases you may be referred to a specialist, the urogynecologist, who can offer lots of options from medications to surgery.  You can even be fitted for a vaginal insert, a pessary, that helps to lift the bladder and compress the uretha for a reduction of symptoms.

Whatever your treatment choice, success is possible.  Start today.  Strengthen your PC now for a cold and flu season without extra panty liners.  Twenty Kegel’s a day. . .

A board certified emergency physician, Jennifer Hanes, D.O., discovered that patients have greater success when they understand their bodies.  With that unique philosophy, she founded Empowered Medicine, PLLC, where knowledge is powerful medicine.  She empowers patients with her articles, motivational speeches and private consultations.  You can learn more at www.DrHanes.com

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