Mater Private: Finding solutions for stress incontinence

Urology surgeon Ms Helen Hegarty (inset) suggests regular Kegel exercises to prevent urine leakage.

Ms Helen Hegarty is a urology surgeon at Mater Private Hospital. She lives in Cork with her husband Paul, also a urology surgeon, and their three children.

One of her specialities is the diagnosis and treatment of stress urinary incontinence in women. 

She understands that this is a sensitive issue which can be embarrassing for women and cause unnecessary limits to the extent that women can enjoy their social and private lives. However, there are many treatment options as Helen explains.

Stress incontinence happens when physical activity such as coughing, sneezing, running or heavy lifting exerts increased pressure on your bladder. 

It is much more common in women than men, incidence increases with age and after childbirth. 

With stress incontinence, women may feel embarrassed, they may isolate themselves and avoid public places which impacts on their social life, exercise and leisure activities. 

Stress incontinence happens when the muscles and supporting tissues around the bladder and the muscles that regulate the release of urine become weakened. 

The bladder expands as it fills with urine and normally muscles that behave like valves in the urethra stay closed as the bladder dilates preventing urine leakage, but when those muscles weaken, anything that exerts force on the abdominal and pelvic muscles can put pressure on your bladder and cause urine leakage.

Factors that increase the risk of developing stress incontinence include age where physical changes associated with ageing, such as the weakening of muscles, may make you more likely to develop stress incontinence. However, occasional stress incontinence can occur in women of any age. 

The type and frequency of childbirth can increase the risk as can being overweight.

Weight loss can certainly improve stress urinary incontinence. 

Pelvic surgery such as hysterectomy alters the function and support of the bladder and urethra, making it much more likely for a person to develop stress incontinence.

There are many options that women can consider for treating stress incontinence, however, the first option should be to strengthen the pelvic floor muscles which can help prevent urine leakage. These exercises are called Kegel exercises.

Firstly make sure you are targeting the right muscles by stopping urine flow in midstream when you achieve that you’ve got the right muscle group. Don’t keep repeating this test, it is just to ensure you have identified the right group. 

You may find it easier to start practising while lying flat although you can do Kegel exercises in any position and in fact anywhere. 

Now for five seconds tighten your pelvic floor muscles, and then relax for five seconds. 

Try it four or five times in a row and work up to keeping the muscles contracted for 10 seconds at a time, then relaxing for 10 seconds. 

Avoid holding your breath. Instead, relax and try to avoid tightening the muscles of the abdomen. Aim for at least three sets of 10 repetitions a day.

There are other options including surgery and this requires a full assessment by a urology surgeon.

Ms Hegarty recommends you take the first step and visit your family doctor or practice nurse. It is not easy but when you have spoken to a professional its gets better and you can start to understand the causes and treatment options.

For example one of the most common surgical procedures she performs is the sling procedure where the surgeon uses the patient’s own tissue or synthetic material to create a sling or hammock that supports the urethra and alleviates the stress incontinence.

Ms Hegarty meets women every week at clinic with stress incontinence and she understands it’s difficult to talk about it, however, there are solutions often it doesn’t involve surgery; you just need to take the first step and ask.


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