Dear Dr Mitchell,
I have six children, the last one two years ago. I leak when I cough or laugh, and this causes great embarrassment. What can be done about this?
The problem that you are experiencing with the involuntary loss of urine on coughing, sneezing or laughing is a fairly common problem in women who have delivered multiple babies by the vaginal method. This is called urinary stress incontinence.
This problem is sometimes seen in women who deliver big babies four kilogrammes and over, have forceps or vacuum delivery, prolonged second stage of labour with excessive pushing, obese women with excessive pressure on the pelvic floor and bladder, diabetic women, and women with a history of chronic constipation and straining to pass stools.
In some women there is associated prolapse of the uterus (womb), bladder and rectum. A urinary tract infection can also present in this manner. If there is a bladder infection you will have the urge to pass your urine frequently, feel an urgency to rush to empty the bladder, and leak urine on coughing or laughing. It is important to rule out a urinary tract infection even if there is obvious prolapse of the bladder and uterus.
Pelvic floor exercises can help to improve your symptoms. In doing these exercises, Kegels, you should:
1. Make sure that your bladder is empty then sit on the floor.
2. Tighten your pelvic floor muscles. Hold tight and count three to five seconds.
3. Relax the pelvic floor and abdominal muscles and count to three to five seconds.
4. Repeat the steps 10 times, three times a day.
These exercises will strength the pelvic muscles, support the pelvic organs, and help to control incontinence of urine, bowel and gas.
If there is prolapse of the uterus, rectum and bladder a ring pessary can be used long term or short term to help to reduce the prolapse until this can be corrected by doing surgery.
In older women who do not want to do surgery it can be used long term but needs to be cleaned and re-inserted into the vagina every three months.
If you are overweight, have a chronic cough, smoke, or suffer from chronic constipation, all these risk factors need to be addressed before surgery to reduce the risk of recurrence of the prolapse after surgery.
In a small group of women there might not be any infection or prolapse of the pelvic floor and the actual problem is an inadvertent weakness in the bladder muscles so that the neck of the bladder does not close effectively. This can be corrected with surgery also.
In some cases the urologist can inject substances into the tissues to strengthen the bladder base and reduce incontinence.
Consult your doctor who will advise you further.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to email@example.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5 or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
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