Expert Health Articles

The Burch is Back!

Dr. Miguel JordanDr. Miguel Jordan

OBGYN, Blanchard Valley Women & Children’s Center

If running, lifting, coughing, laughing or sneezing causes you to unintentionally and unexpectedly lose small amounts of urine, you may have urinary stress incontinence. Stress incontinence is especially common in women who have had more than one pregnancy through vaginal delivery. The condition is typically caused by physical changes in the body such as pregnancy and childbirth, menstruation, menopause, surgery, and/or weakened bladder muscles. If you have this, you’re not alone. In fact, the annual direct cost of urinary incontinence in the United States was estimated as $16.3 billion dollars in 1995.

Stress urinary incontinence can be a very uncomfortable and inconvenient health issue. While some women may believe that accidental urine leakage is bound to happen as they get older, the truth is that the problem can be minimized with the right self-help techniques and treatment.

Kegels are pelvic muscle training exercises that can be done at any time. To do Kegel exercises, squeeze the sphincter muscles as if you are trying to stop the flow of urine. While contracting these muscles, try not to move your legs, buttocks or abdominal muscles. If you are doing the exercises correctly, no one should be able to tell that you are doing Kegels. Kegel exercises help strengthen the muscles that support the bladder, uterus and bowels, which can help prevent urinary leakage.

In addition to these simple exercises, women can also change certain behaviors that may increase their risk of stress urinary incontinence. Examples include:

  • Urinating more frequently to reduce the amount of urinary leakage
  • Avoiding drinking alcohol or caffeinated beverages, which stimulate the bladder
  • Losing weight if you are overweight
  • Quitting smoking, which can reduce coughing, bladder irritation and the risk of bladder cancer
  • Avoiding foods that can irritate the bladder, such as citrus fruits and spicy foods

If you are a woman and you are unable to control stress urinary incontinence with these behavior changes, medication or other procedures may be able to improve symptoms. Treatment options include biofeedback, pessaries and even surgery in some cases.

Biofeedback takes information happening in the body and displays the information in ways that are easy for individuals to understand. Biofeedback can be effective in treating urinary incontinence by showing women the muscles they are training when they do Kegel exercises. By placing a few sensors on areas of the lower body and doing Kegel exercises, biofeedback can display a women’s pelvic muscle strength through computer graphs and audible tones. Being able to see, hear and understand the pelvic muscle activity may help individualize and improve a woman’s Kegel exercises, which can help prevent urinary leakage.

Medical devices such as pessaries can also help women manage urinary incontinence. A pessary is a small ring or disk that is inserted into the vagina. The device is typically made of silicone or latex and can be worn all day. A pessary is prescribed, fitted and inserted by a doctor, and helps support the bladder to prevent urine leakage.

In more severe and long-term cases of urinary incontinence, surgery may be necessary. One surgical option for stress urinary incontinence treatment is a mesh sling procedure. In this type of surgery, strips of mesh are used to create a sling beneath the neck of the bladder and the urethra (the tube that carries urine), which helps keep the urethra closed when women cough, laugh or sneeze. The Burch procedure, considered the gold standard, is a mesh free technique and can be done openly or robotically to return support of the urethral vesicle angle (neck of the bladder). Both procedures typically have low complication risks and high rates of effectiveness in treating urinary incontinence.

Talk to your doctor about treatment options if you are concerned about female stress urinary incontinence.