Many women are afraid to discuss their stress incontinence symptoms with their doctor because they fear that their only option for treatment is “that mesh thing”. In fact, when I see women for stress incontinence problems and recommend pelvic floor physical therapy, they often become rather skeptical. Often, they will say; “Oh, you mean those Kegel exercises? I tried those and they didn’t help”. Kegel exercises are to pelvic floor physical therapy what untrained weightlifting is to bodybuilding: Sometimes, it works out, and sometimes it doesn’t. Going to the gym and lifting weights without being properly trained opens one up to bad habits, suboptimal training regimens, and at worst, injury. I have seen women who overdid their Kegel exercises and ended up with pelvic floor muscle spasms and pain, leading them to believe that the exercises didn’t work. Fortunately, we have good scientific data to support pelvic floor physical therapy as a first-line treatment for stress incontinence. Studies have shown that women with shorter duration stress incontinence do best, but even those with longer duration of symptoms are likely to benefit. The best reason for working with a physical therapist is that it may improve symptoms enough to eliminate the need for surgical treatment. Studies have shown a 60-80 per cent chance of significant improvement in symptoms using physical therapy with behavior modification. It seems obvious that something this effective is worthwhile, at least as an initial treatment. There are no surgical risks, there is no “downtime” or recovery period, and the cost is minimal compared with surgery.
There is also a device that can be used, InTone (R), which allows a woman to perform her own physical therapy regimen at home. More insurances are covering this device, which also has good data to support its use. If a woman is unable or unwilling to come in for regular physical therapy sessions, this may be a good option.
If physical therapy is not an option, there is another nonsurgical treatment that may be suitable for women with fairly specific types of stress incontinence. For example, women who complain only that they leak during heavy physical exercise (eg: boot camp, golfing, dancing, martial arts or other sports), there is a small plug that a woman can learn to insert into her urethra which will block passage of urine for a short period of time. It can only be worn for a few hours and can not be reused, but it is relatively inexpensive and can be very effective in preventing leakage. The plug is made of inert silicone filled with mineral oil at the tip, and comes with sterile gel and an applicator guide. The name of the insert is FemSoft (R), and it comes in a few different sizes. Your urogynecologist can fit you with the insert if you are interested. It is not difficult to use, and although it may slightly increase the risk for a bladder infection, it may be an excellent means to prevent leakage in specific situations.
Another option available is an incontinence pessary. This is a device worn in the vagina to reduce the amount of urethral mobility (dropping), thus reducing leakage. For some women, this can be a very helpful option. A properly fitted pessary should not be noticeable when worn, and should help with mild prolapse symptoms as well.
There is one particular group of women for whom physical therapy is recommended even when symptoms are mild: postpartum moms. Women who have delivered a baby recently often will have transient incontinence. Typically, even with no treatment the incontinence symptoms improve, however, physical therapy is likely to hasten this recovery and may help prevent problems in the future.
For more information regarding nonsurgical treatment of stress urinary incontinence, you may request an appointment at 561-701-2841