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Suppose you’ve been dealing with bladder leaks when you cough, laugh, or sneeze. In that case, you’re probably well aware that you’re dealing with stress urinary incontinence, or SUI. And you’re ready to do something about it.

There are many natural remedies that we’ve discussed previously in this article: Why Do I Get Bladder Leaks When I Cough and What Can I Do About it? But if you’ve already given a good try with the Kegels, lifestyle changes, and pessaries like Uresta, only to find that you’re still struggling to keep your bladder in line, then you may be contemplating surgery to fix the problem.

While surgery isn’t for everyone, it is an option on the table for those with persistent stress urinary incontinence that have tried other treatments without success. There are three major types of surgical interventions used to treat SUI. Let’s find out more about each one to find out which option is right for you.

Injections for Treating SUI

Before resorting to full-blown bladder surgery, there is an in-between step that is more drastic than natural remedies—but less invasive than surgery. This option involves injecting synthetic bulking material (similar in consistency to natural collagen) into your tissues around the urethra in order to plump and tighten the bladder neck opening and keep urine inside the bladder when you cough or apply pressure.

These injections are done as a minor, outpatient procedure in your local doctor’s office in less than half an hour. Here’s how it’s done:

  1. A local anesthetic is given to help numb the area
  2. A scope is inserted into the urethra for visual accuracy
  3. The material is injected into the tissues around the bladder

It’s important to note that these injections are not a permanent solution. It may take multiple injections and must be repeated to maintain the results. These injections usually help decrease leaks, but ultimately, they are not a cure. The success rate is around 80% of women showing an improvement after three injection visits, but only 10-30% are cured of leaks for up to a year.

Urethral Sling for Treating SUI

A more invasive surgical operation for treating stress urinary incontinence urethral sling surgery. Think of a sling as a supportive hammock that lifts your pelvic organs, particularly the bladder and urethra, into position for proper alignment. Sometimes with age, childbirth, and other factors, our bladder organs sink and move from their original positions, resulting in incontinence and other issues like pelvic organ prolapse.

Related: Pelvic Organ Prolapse (POP) Explained by Your Las Vegas OBGYN Team

Urethral slings are used to realign your anatomy so that your bladder organs can function properly. The material for the sling can either be made of synthetic mesh (called a mid-urethral sling) or from donor tissue removed from your belly or thigh (traditional or autologous sling).

Surprisingly, mid-urethral sling surgery can be completed as quickly as half an hour and can be done as an outpatient procedure because it has a quick recovery time. However, there are risks to using a synthetic mesh, including mesh erosion which affects 2% of women and leads to long-term problems until removed. It is also not advised for patients who wish to give birth in the future.

While the synthetic mesh is the most common type of SUI sling surgery with a success rate of around 75%, the traditional sling is the solution in the event of a bad reaction with the synthetic version. This surgical procedure is more in-depth and requires a short hospitalization stay during your recovery time. There is a higher risk of UTIs and incontinence after undergoing traditional sling surgery.

Sling procedures can be performed through a variety of methods, from one or more incisions in the abdomen, through the vagina, or even laparoscopically. Your surgeon can guide you through where any incisions will be made for your procedure. Be sure to ask your doctor questions about success rates and risks for the procedure that you’re considering.

See the FDA’s list of specific questions to ask your surgeon before proceeding with a sling surgery, including:

Bladder Neck Suspension for Treating SUI

Colposuspension, also called the Burch procedure, is another surgical option for treating SUI in women. This is a procedure where stitches are used to align the bladder neck (where the urethra meets the bladder) back to its proper place and can be done either through an abdominal incision or laparoscopically as an outpatient procedure.

Complications are usually less severe than sling procedures and include the possibility of having to go back in and loosen stitches if you have trouble emptying the bladder after the operation. The success rate of bladder neck suspension for SUI treatment is around 85%.

Choosing the Best Treatment Option for Your Bladder Leaks

Living with stress incontinence certainly puts a damper on life. If you’ve tried everything and nothing has worked, surgery may be your next plan of action. If you’re considering bladder surgery for your SUI, talk with your doctor about which surgical option is best for your situation. Your doctor will help you consider factors like your age, future plans for childbearing, medical history, and the root cause of the problem in order to come to the best treatment option.

My Virtual Physician supports patients through counseling and patient education when making big decisions like undergoing bladder surgery. We can also see you virtually from the comfort of your own bed in the event that you’re recovering from surgery and have concerns. Please don’t hesistate to reach out to us today.

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One in three women lives with bladder leaks caused by stress urinary incontinence (SUI). SUI is when you leak a little urine when pressure is applied to the bladder—like when you cough, laugh, or sneeze. As you age, your chances of developing SUI increase. The main cause is a lack of muscle tone and a weakened structure. And there is a simple solution: the pessary. Let’s explore the pessary.

What is a Pessary?

A pessary is a medical prosthetic that helps to provide structure to the pelvic organs in an attempt to restore the natural shape for proper functioning. As you know—with age, everything starts sagging, and internal organs are no exception. A pessary is essentially a bra for your bladder organs.

These devices have an ancient history, originally made of wax and string until rubber was available in the 1800s. Today, the prosthetic is made of flexible, hypoallergenic material, such as silicone. To use it, a woman inserts the pessary into her vagina. If you search for images of pessaries, you’ll see that these devices come in a wide variety of shapes and sizes.

What Conditions Do Women Use Pessaries For?

Pessaries aren’t just for sealing up bladder leaks. Pelvic organ prolapse warrants another common use for the devices. Since both conditions are caused by a gradual change in anatomy, a prosthetic that restores the original anatomy works. Furthermore, pessaries can even be used to administer medication.

RELATED: Pelvic Organ Prolapse (POP) Explained by Your Las Vegas OBGYN Team

Types of Pessaries

There’s a reason for all that variety you see when looking at pessaries. Each unique shape is designed to support different pelvic organs. Here’s a rundown on the different shapes you might find, but not all of them are used for urinary incontinence:

Ring Pessaries

Resembling a ring you would wear on your finger, the hole in this shaped pessary allows urine to flow through while wearing the device—on your terms. This type is not used for urinary leaks but works to support the internal organs near the cervix. Sometimes the center hole is covered with a thin layer of material with smaller holes.

Lever Pessaries

A less often prescribed shape is the lever pessary. This one is used for correcting the positioning of a tilted uterus and resembles a caribiner.

Gehrung Pessaries

A tiny saddle-looking pessary is the Gehrung version. It’s used in supporting the rectal and bladder anatomy and is inserted near the cervix.

Shaatz Pessaries

Used for pelvic organ prolapse, Shaatz pessaries are shaped like a washer that has additional pinholes around the perimeter.

Cube Pessaries

Cube pessaries look like small dice (like playing dice) with concave sides and a string attached. These are used for mild pelvic prolapse.

Gelhorn Pessaries

Severe pelvic organ prolapse requires the Gelhorn pessary, which resembles a kitchen sink strainer plug. The flat side rests against the cervix, with the protrusion facing the vaginal opening.

Inflatable Pessaries

Inflatable pessaries can be used for mild conditions. The shape conforms to your body as you inflate it with a hand pump.

Unique Pessaries

Other uniquely-shaped pessaries have been developed over the years. One example is Uresta, a pessary that is shaped like a small cylinder with nubs on the sides. The shape keeps the device in place and puts minor pressure on the urethra to prevent bladder leaks.

With so many different types of pessaries available, it can be challenging to pick the right type for your body and may require some trial and error. Let our doctors assist with the process by giving you our expertise and the tools to try out a pessary to see if it helps you with your stress urinary incontinence.

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How to Use a Pessary for Stress Urinary Incontinence

Once you and your doctor pick the right pessary to try, the first step is to get the right fit. With Uresta, our partner in managing urinary incontinence, there are five sizes available for you to try in a self-fitting at home. Other pessaries may require fitting inside a doctor’s office. Pessaries are inserted similarly to a tampon without an applicator or similar to a diaphragm.

With a proper fit, you will:

Patients can self-manage their use of the pessary. Read the instructions on how to insert and how long the pessary can remain in place, as well as cleaning steps. Some women choose to only use the pessary during workouts, while others wear it all day long and remove it before bed. Your pessary will need to be replaced every year or as directed.

A Pessary to Stop Your Bladder Leaks

If you’re living with annoying bladder leaks when you cough or put any pressure on your abdomen, you’re probably fed up with the nuisance. A pessary can allow you to return to a normal life, enjoying all of the activities that you once did. If you’re interested in trying Uresta or another pessary for stress urinary incontinence, reach out to our team today.

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The truth About Kegals & Bladder Leaks

You may have heard of doing Kegels to improve your sex life, but did you know that these intimate exercises can help improve bowel and bladder problems too? If you’ve got bladder leaks when you cough, laugh, or sneeze, then doctor-approved Kegels may help. Let’s explore the truth about Kegels.

What are Kegels?

The term “Kegels” was coined in 1948 by Dr. Arnold Henry Kegel. He was a specialist looking for a natural remedy for urinary incontinence. Kegels are a category of exercises that are designed to strengthen the pelvic floor muscles. These muscles can be identified easily by stopping the flow of urine while peeing.

A woman’s pelvic floor muscles and tissues are similar to a hammock, supporting these organs inside her pelvis from underneath:

Pelvic floor exercises were originally developed to target this group of muscles that weaken with aging, pregnancy, and prolapse in women and to prevent and treat certain types of incontinence, including stress urinary incontinence.

To help gauge the effectiveness of Kegel exercises for the treatment of urinary incontinence, Dr. Kegel invented the perineometer, a device that measures the strength of contractions of the pelvic muscles. This device also helps trained physical therapists validate that female patients are performing the exercises correctly.

Related: Why Do I Get Bladder Leaks When I Cough and What Can I Do About it?

Bladder Exercises for Stress Urinary Incontinence

Now that you know that Kegels are just a group of pelvic exercises, let’s talk about specific exercises and programs that are often used to treat stress urinary incontinence.

Anyone can add Kegels to their daily routine to strengthen pelvic floor muscles. As with any exercise program, start out small and work your way up to longer durations and if you experience any discomfort, stop and discuss it with your doctor. Before you begin, empty your bladder.

There are two main Kegel exercises to work on from home, they include:

  1. Long Hold
  2. Short Muscle Contractions

Alternating between the long and short contraction exercises is recommended for best results.

Long-Hold Kegels

Long-hold exercises require you to tense your pelvic floor muscles constantly for several seconds, release, and then repeat. Starting out, you can go with:

Continue this on a daily basis once per day. Once you get into a routine, you can increase to 10 seconds of contraction, 10 seconds of release, and 10 reps. After that, you can further increase your pelvic floor muscle tone by adding up to three sessions of 10 reps per day.

Short-Muscle Kegels

Short Kegels work out the same group of muscles, but the contraction period is much shorter, at one or two seconds. These are especially effective at improving bladder sphincter function. As with long-hold pelvic floor exercises, you can start small and work your way up to three sets of 10 seconds per day.

While you complete these exercises, be sure to continue breathing and avoid tensing other muscles in your body, such as your abdomen. You can add intensity to your routine by performing the exercises in different positions: sitting, standing, or lying down.

For consistency, associate these exercises with certain times of the day or write them down. For example, you may designate the first pee of the day as your time to complete your Kegels—after you’ve emptied your bladder and while you’re still on the toilet.

Related: Stop Bladder Leaks: Get Your Life Back with This Doctor-Approved Device

How Do I Know if Pelvic Floor Muscle Training is Working?

It usually takes about a month to notice an improvement once you consistently exercise your pelvic floor muscles. That means that you’ll want to commit to a solid month before deciding if it worked or not, but the recommended minimum training period is eight weeks.

If you don’t feel comfortable doing Kegel exercises on your own, struggle with consistency, or you’re still not sure you are doing it right, you’re not alone. Studies have shown that treatment is more effective when you complete these pelvic exercises in a supervised plan. Work with your doctor to find a physical therapist (called a pelvic floor therapist) who will personalize a plan to fit your unique anatomy.

Signs that the Kegels are working include:

Beyond the Kegels

While it’s true that Kegels are effective at preventing and treating stress urinary incontinence, not every woman is able to contract the pelvic muscles correctly. Three out of ten women are unable to perform Kegel exercises properly. If this is you, other effective options are available for treating SUI. A few other natural solutions to leaky bladders include to:

Pessaries can be used alongside performing Kegels or as a standalone solution. These small devices are inserted into the vagina in order to support your anatomy and keep your pelvic organs and muscles aligned to reduce leaks.

If you’d like to try a pessary for your leaky bladder, My Virtual Physician has partnered with Uresta to provide a solution to stress urinary incontinence. Book an appointment today to get your bladder back under your control.

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Imagine you’re at work, having a good laugh with coworkers. Suddenly, you feel something down below. Did you just pee yourself? It happens once, and you think… maybe it’s just a one-time thing. But then it continues to get worse over the next year and happens while coughing and sneezing, too. What’s going on?

It’s called stress incontinence. And while it’s not a normal part of aging, it is common. In fact, 4 in 10 women over the age of 40 deal with some form of urinary incontinence. Stress incontinence is the most common type for women. Let’s learn more about what causes these bladder leaks when you cough, sneeze, or laugh.

What is Stress Incontinence?

Think of stress incontinence like a water balloon that is held closed with your finger and thumb but not closed. The balloon is your bladder, the water is your urine, and your fingers are holding your bladder sphincter muscles closed, keeping the liquid in. When you squeeze the balloon hard enough, the water squirts out. The bladder works in a similar manner.

Stress urinary incontinence, also abbreviated SUI, happens when too much pressure pushes urine out of your bladder. Pressure happens when you tense your abdominal muscles; which happens every time you laugh, cough, and sneeze. It can also happen when you bend, lift, or jump.

What Causes Stress Urinary Incontinence?

As we age, have babies, or undergo surgery, our muscles tend to lose muscle tone and bodyparts don’t always stay where they should. SUI is usually caused by weakened pelvic muscles. Those aren’t the only risk factors that can cause or worsen stress urinary incontinence. Here are a few more:

What Can I Do to Stop a Leaky Bladder When I Cough?

The great news about stress urinary incontinence is that there are plenty of natural ways to treat and prevent it. Let’s review some things that you try.

Pelvic Floor Exercises

Since the problem is usually caused by weak muscles, the first solution to try is muscle strengthening exercises. But how in the world do you strengthen your bladder muscles? It’s not actually your bladder, but your pelvic floor muscles that you’ll want to pay attention to. You can find common pelvic floor exercises online or work with your doctor to come up with personalized exercises to improve your pelvic muscle tone.

Lifestyle Changes

Other natural ways to deal with the problem include using the restroom more often so that there is less urine in your bladder and it’s less likely to be pushed out with increased physical pressure from laughing or coughing. You could also try tensing your pelvic floor muscles before laughing, coughing, or sneezing.

Losing weight, drinking less caffeine, quitting smoking, and drinking less in general are also lifestyle changes that could reduce your incontinence.

Ask Your Doctor About a Pessary

If these methods don’t work for you, there is another option on the table for most women: a pessary. Pessaries are medical devices that are inserted into the vaginal canal to help support the structure of pelvic organs, tissues, and muscles. It provides extra support to the bladder and sphincters to keep them in the correct position and reduce the chance of stress incontinence.

 

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My Virtual Physician has partnered with Uresta to provide a fitting-free pessary option to our patients who want to manage their stress urinary incontinence. If you’ve got a leaky bladder and want to explore your options, set up an appointment with our doctors today so that we can get you back to feeling yourself again.

Surgery

If all else fails and you can’t reduce or treat your stress urinary incontinence with the above methods, surgery is another solution on the table. The surgical solutions to SUI include injections, urethral slings, or colposuspension. Injections are the least invasive option and can be done in a doctor’s office. The other two surgical options can be done laparoscopically. Your doctor can help you decide which type of surgical treatment might be best for your situation.

Sealing Up the Leaks

Living with bladder leaks when you cough, laugh, or sneeze puts a real damper on life. Luckily, there are many solutions to treat stress urinary incontinence so that you can get back to enjoying life to its fullest. Get in touch with My Virtual Physician if you want personalized SUI treatment.

 

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