Treating female "stress incontinence"?
January 25, 2023 12:09 AM Subscribe
Fiftyish lady here, finding myself peeing a little bit when I cough or sneeze. Dr. says treatable, but every treatment option sounds awful. But I'd love to have my mind changed. If you (or someone you know) have tried treating stress incontinence with either physical therapy, or pessary, or surgery, can you tell me about it?
If it's relevant, I hate even regular PT, and I really, really hate going to the gyno, so I doubt I'm a candidate for the PT. Realistically, I don't think I could handle it. But if you found it transformative, I'd think about it.
Pessary: If someone were to assure me that it solved the problem, I would consider it worth it to get one fitted and try it. So most interested in anecdata here.
Surgery: Probably not willing to do surgery for this, for fear of bad (painful) result. But interested in others' experience.
If it's relevant, I hate even regular PT, and I really, really hate going to the gyno, so I doubt I'm a candidate for the PT. Realistically, I don't think I could handle it. But if you found it transformative, I'd think about it.
Pessary: If someone were to assure me that it solved the problem, I would consider it worth it to get one fitted and try it. So most interested in anecdata here.
Surgery: Probably not willing to do surgery for this, for fear of bad (painful) result. But interested in others' experience.
My logic for decisions like this is to start with the least invasive option. In your case, that would mean trying your options in the order you presented them.
Here's some suggestions from a skim of google scholar articles + scihub as needed. But first, I'd like you to know that at least one thing I read said that this is a very common experience, it happens to nearly half of people who are post-menopause.
Avoid caffeine and cigarettes. Something about estrogen, something about weight loss. Eat enough fiber. Manage your blood sugar. Get enough exercise, especially low impact. And don't take up the trampoline. Most elite trampolinists apparently deal with this: "as high at 80.0%"
posted by aniola at 12:54 AM on January 25, 2023 [2 favorites]
Here's some suggestions from a skim of google scholar articles + scihub as needed. But first, I'd like you to know that at least one thing I read said that this is a very common experience, it happens to nearly half of people who are post-menopause.
Avoid caffeine and cigarettes. Something about estrogen, something about weight loss. Eat enough fiber. Manage your blood sugar. Get enough exercise, especially low impact. And don't take up the trampoline. Most elite trampolinists apparently deal with this: "as high at 80.0%"
posted by aniola at 12:54 AM on January 25, 2023 [2 favorites]
I would try vaginal estrogen cream before I tried anything else.
posted by Violet Hour at 1:00 AM on January 25, 2023 [4 favorites]
posted by Violet Hour at 1:00 AM on January 25, 2023 [4 favorites]
I did pelvic floor PT for similar issues and it. Was. Transformative. Seriously. If there’s any way you can give it a shot I highly recommend. It was like … maybe 8 sessions? I did have a thing where I used a wand inserted (by me) to measure my muscles because it turns out my issue wasn’t being strong it was relaxing. As in I never did.
This was probably six years ago. I’m returning because I seem to have forgotten how things go after falling out of complaints with my routine.
There are now personal at home devices that will train this on your phone. I’ve never used them but if pt is really out of the question perhaps they are worth a shot?
If you want more specific details or have specific questions I’m happy to chat more if you send a dm!
posted by dpx.mfx at 1:07 AM on January 25, 2023 [6 favorites]
This was probably six years ago. I’m returning because I seem to have forgotten how things go after falling out of complaints with my routine.
There are now personal at home devices that will train this on your phone. I’ve never used them but if pt is really out of the question perhaps they are worth a shot?
If you want more specific details or have specific questions I’m happy to chat more if you send a dm!
posted by dpx.mfx at 1:07 AM on January 25, 2023 [6 favorites]
The PT i did for this problem did not involve a therapist. I bought over the counter excercise cones / Kegel weights for pelvic floor weakness, and it was simple to do on my own.
Googling just now i saw that many are offered with an app. Personally i would not use an app. They are easy to use without an app tracking your private parts.
What is useful is to cough occasionally while you do it and feel and see in the mirror what your muscles need to do to contract.
It definitely helps, but only for mild weakness.
posted by 15L06 at 1:59 AM on January 25, 2023 [2 favorites]
Googling just now i saw that many are offered with an app. Personally i would not use an app. They are easy to use without an app tracking your private parts.
What is useful is to cough occasionally while you do it and feel and see in the mirror what your muscles need to do to contract.
It definitely helps, but only for mild weakness.
posted by 15L06 at 1:59 AM on January 25, 2023 [2 favorites]
Strong second for vaginal estrogen cream. My GP says it carries very little risk compared to the pill form and has helped me tremendously. I use and love and higly recommend the NHS's app Squeezy for timed pelvic floor exercises. And maybe also investigate online PT for rebuilding core and pelvic strength post-partum. I've used MommaStrong and she has specific rehab work for incontinence.
posted by abecedarium radiolarium at 2:11 AM on January 25, 2023 [3 favorites]
posted by abecedarium radiolarium at 2:11 AM on January 25, 2023 [3 favorites]
I was super-kegal woman, so much so that my gyno warned me not to exercise too much. There's an anti-depressant that has a weird side effect of reducing female incontinence.
Duloxetine
How it works
Duloxetine (Cymbalta, Drizalma Sprinkle) is a serotonin and norepinephrine reuptake inhibitor that is approved to treat depression and anxiety. It can help relax the muscles that control urination and improve bladder leaks in some people. It might be especially helpful for people who have urinary incontinence and depression.
Mayo Clinic
posted by b33j at 2:51 AM on January 25, 2023 [2 favorites]
Duloxetine
How it works
Duloxetine (Cymbalta, Drizalma Sprinkle) is a serotonin and norepinephrine reuptake inhibitor that is approved to treat depression and anxiety. It can help relax the muscles that control urination and improve bladder leaks in some people. It might be especially helpful for people who have urinary incontinence and depression.
Mayo Clinic
posted by b33j at 2:51 AM on January 25, 2023 [2 favorites]
A (generally very good) primary care practice near me has been talking up a machine/treatment called Emsella, which apparently is something you can do completely clothed and magically (with science) works your muscles through the equivalent of thousands of kegels. I think it is pricey but sounds like it might be a good option for you given your hesitation about other strategies.
posted by needs more cowbell at 3:17 AM on January 25, 2023
posted by needs more cowbell at 3:17 AM on January 25, 2023
Please. please. please do the PT. It's the only thing were I am an embarrassing mother to my girls (I think). Do your kegels.
My mother suffers from continuous life threatening infections because of her incontinence. She almost died last week. My gran was more keen on bathing than my mother is, but still struggled with infections, because somehow in my family it has been embarrassing to talk about maintaining health. Even my progressive aunt hasn't talked about it.
posted by mumimor at 3:39 AM on January 25, 2023 [2 favorites]
My mother suffers from continuous life threatening infections because of her incontinence. She almost died last week. My gran was more keen on bathing than my mother is, but still struggled with infections, because somehow in my family it has been embarrassing to talk about maintaining health. Even my progressive aunt hasn't talked about it.
posted by mumimor at 3:39 AM on January 25, 2023 [2 favorites]
+ 3 for vaginal estrogen cream and PT .
posted by SunPower at 4:29 AM on January 25, 2023 [1 favorite]
posted by SunPower at 4:29 AM on January 25, 2023 [1 favorite]
If you want to try something on your own before going to a professional, MommaStrong has a program addressing incontinence. I haven’t done this one, but I’ve been doing other MommaStrong workouts for years; I credit that with healing my diastasis recti.
posted by Kriesa at 4:41 AM on January 25, 2023 [1 favorite]
posted by Kriesa at 4:41 AM on January 25, 2023 [1 favorite]
Here's my PT experience:
My first appointment, with my permission and lots of checking in, I disrobed from the waist down and the physio looked and confirmed that I was doing kegels correctly. Optionally, they checked a reflex with a gloved finger. I was pregnant at the time.
Another appointment (post partum this time) was similar, but this time (and again, I could have declined) a gloved finger was inserted in vagina to screen for prolapse.
Most of the appointment was discussing what kind of simple things I could add to my life and what to look out for.
Definitely try the PT.
posted by freethefeet at 4:46 AM on January 25, 2023 [2 favorites]
My first appointment, with my permission and lots of checking in, I disrobed from the waist down and the physio looked and confirmed that I was doing kegels correctly. Optionally, they checked a reflex with a gloved finger. I was pregnant at the time.
Another appointment (post partum this time) was similar, but this time (and again, I could have declined) a gloved finger was inserted in vagina to screen for prolapse.
Most of the appointment was discussing what kind of simple things I could add to my life and what to look out for.
Definitely try the PT.
posted by freethefeet at 4:46 AM on January 25, 2023 [2 favorites]
My MIL hates PT, hates doctors, we had to drag her to the ER when she was having a possible stroke (it was a concussion instead, thank goodness), and the pelvic floor PT has been a lifesaver (probably literally, she too tried to die from a UTI a couple of years ago).
posted by joycehealy at 4:58 AM on January 25, 2023 [1 favorite]
posted by joycehealy at 4:58 AM on January 25, 2023 [1 favorite]
I know multiple people (all cis women who have been pregnant, fwiw) who have done pelvic floor PT for stress incontinence and every single one has found it to be incredibly helpful and worth the initial awkwardness.
posted by maleficent at 4:59 AM on January 25, 2023
posted by maleficent at 4:59 AM on January 25, 2023
I will add to the chorus here that PT is incredibly helpful. In my experience, pelvic floor physical therapists are a different breed from other medical professionals in that they are incredibly supportive and understanding. They get how awkward and weird the situation is. Just tell yours how you’re feeling and she’ll help make you more comfortable. PT is really important because it’s easy to assume that you can just do Kegels and fix the problem—some people can!—but some of us need to do the opposite because our pelvic floors are super tight and Kegels make the issue worse. A physical therapist can help you sort it out and send you home with ways to work independently.
posted by corey flood at 6:34 AM on January 25, 2023 [8 favorites]
posted by corey flood at 6:34 AM on January 25, 2023 [8 favorites]
I read on some website that I can't find again that most urinary incontinence is caused or exacerbated by even mild constipation. My experience as a post-menopausal person confirms this. Most Americans don't eat enough fiber, and it's good for you, so there's no downside to making sure you get plenty of fiber. Eat oatmeal, dried apricots, fruit, vegetables, whole grains, beans, bran.
and do the Kegels or even go to PT.
posted by Mom at 7:08 AM on January 25, 2023 [4 favorites]
and do the Kegels or even go to PT.
posted by Mom at 7:08 AM on January 25, 2023 [4 favorites]
I got a pessary last week and I’m super bummed it’s not helping me - I’m going to get into PT soon for this. Good luck.
posted by tristeza at 7:18 AM on January 25, 2023
posted by tristeza at 7:18 AM on January 25, 2023
Note: my problem was too many Kegels and too much strength. So just doing Kegels might not be good for you.
My pt explained that you need a full range of muscle movement for it to work well. If you’re talking about your arm, it’s better to get a full range than to start with your arm at a 90 degree angle. I’d done so many Kegels and carried all my stress in my pelvic floor that I was starting from half tense all the time. There was also nerve damage involved but that was a separate issue.
Anyway. Kegels are good but too many are bad, is what I’m saying.
posted by dpx.mfx at 8:26 AM on January 25, 2023 [2 favorites]
My pt explained that you need a full range of muscle movement for it to work well. If you’re talking about your arm, it’s better to get a full range than to start with your arm at a 90 degree angle. I’d done so many Kegels and carried all my stress in my pelvic floor that I was starting from half tense all the time. There was also nerve damage involved but that was a separate issue.
Anyway. Kegels are good but too many are bad, is what I’m saying.
posted by dpx.mfx at 8:26 AM on January 25, 2023 [2 favorites]
I used to work in a women's clinic. All of the women we referred to pelvic floor PT came back saying it was life changing. I'd say give it a try if you can.
posted by CleverClover at 8:36 AM on January 25, 2023 [4 favorites]
posted by CleverClover at 8:36 AM on January 25, 2023 [4 favorites]
I don’t see if anyone’s suggested/offered you a PeriFit? Idk where you are and maybe it’s the same as the Squeezy app mentioned upthread? Anyway it’s a PT app on a device that you insert in your vagina and play video games that isolate specific muscles/areas of focus in your pelvic floor. I know several ppl who’ve used perifit and say not only is it effective and not awful, it’s actually fun. I hope you get a solution that satisfies you.
posted by toodleydoodley at 1:25 PM on January 25, 2023 [1 favorite]
posted by toodleydoodley at 1:25 PM on January 25, 2023 [1 favorite]
A perspective on pelvic floor PT from someone who also hates the gyno -
The physical therapist doesn't use a speculum for an exam (which is a huge part of the discomfort for me) and their approach is really gentle and helpful. Not every visit involved an exam; there was also a lot of education that was really helpful.
For me the experience was totally different from a gyn visit and I learned a lot of helpful information. It wasn't really like regular PT either. It is truly worth a shot.
posted by jeoc at 4:19 PM on January 25, 2023 [3 favorites]
The physical therapist doesn't use a speculum for an exam (which is a huge part of the discomfort for me) and their approach is really gentle and helpful. Not every visit involved an exam; there was also a lot of education that was really helpful.
For me the experience was totally different from a gyn visit and I learned a lot of helpful information. It wasn't really like regular PT either. It is truly worth a shot.
posted by jeoc at 4:19 PM on January 25, 2023 [3 favorites]
I have a close friend who did the PT and she also found it extremely effective. In her case it was an easy choice over medication because she has anxiety around taking pills and possible side effects. It sounded like the therapist was very understanding and reassuring and worked to make sure she was comfortable with everything. She didn’t have to go that often as they gave her exercises to do at home as well.
posted by thejanna at 11:16 AM on January 26, 2023
posted by thejanna at 11:16 AM on January 26, 2023
As it happens, my Perifit, the device toodleydoodley mentions, arrived yesterday. I've also done pelvic floor PT (PF PT) for incontinence, and recently had pelvic surgery (not for incontinence, but rest & recovery has brought on incontinence again).
First, as almost everyone above mentions, the pelvic floor PT specifically for incontinence was the gold standard. It was in a private room with a female PT. There's no speculum. There is a small "wand" you insert, about the size of a bullet vibrator, with wires that trail out and attach to a computer. There's a monitor where you can see your contractions of different muscle groups, and what you're basically doing is biofeedback. You can see, literally and immediately, what you're contracting/releasing and how effectively. The PT runs you through different patterns ("hill" "comb" "wave") at different speeds and you get used to engaging the muscles exactly how you need to.
What was invaluable to me was exactly that matching up of muscles and brain - knowing I was doing what I thought I was doing. As people mention above, releasing is what many people have more trouble with. Anyway, the progression went from lying down doing the exercises, to sitting up, to standing, to standing and moving (like taking lunges or jumping side to side) while also contracting and releasing when you intend to and with the strength you intend to. It was absolutely worthwhile and effective. I think I went once a week for two months, with exercises in-between. However, one thing my PT said was "Don't overdo it!" Many people do kegels too much and without focusing on the release, and then have no power when needed. Knowing what I now do about PF PT, I'm an evangelist. I have exercises I still do when I need to, that are more complicated than just "kegels".
Even if you aren't interested in surgery, it might be really useful to see a uro-gynecologist and talk through the options with them, and what the likely progression is of your incontinence for all the various options. I assumed my issue could be handled by a pessary but learned it could not be. I also learned that no amount of PT was going to fix the structural issues and that it would get worse. Understanding the options and trajectories was helpful for me.
That's what brings me to using the Perifit, because my pelvic and abdominal muscles are weak after surgery. I approached a PF PT looking to do core work so I could go back to strength training safely and she recommended the Perifit to me after hearing I had a good foundation for doing the work on my own. She has used it herself and with other clients.
So far I like it. It has the same focus on biofeedback that I found most helpful. You insert it and calibrate (it also measures different muscle groups, deeper vs. shallow), and then it gives you game-like tasks that you accomplish by contracting and releasing. (Usually the visuals are things like birds or planes where you have to control the altitude.) The app doesn't seem to store/share personal data, but does store your scores so you can progress. Again, the biggest help for me is reconnecting the lines of communication between my brain and my muscles, and having the device serve up a variety of patterns so I'm not just mindlessly contracting and releasing. The instructions also suggest the progression of starting lying down, then moving to sitting, standing, etc. (p.s. size-wise the Perifit is dildo sized vs. the bullet size of the PT wand.)
posted by cocoagirl at 11:17 AM on January 26, 2023 [2 favorites]
First, as almost everyone above mentions, the pelvic floor PT specifically for incontinence was the gold standard. It was in a private room with a female PT. There's no speculum. There is a small "wand" you insert, about the size of a bullet vibrator, with wires that trail out and attach to a computer. There's a monitor where you can see your contractions of different muscle groups, and what you're basically doing is biofeedback. You can see, literally and immediately, what you're contracting/releasing and how effectively. The PT runs you through different patterns ("hill" "comb" "wave") at different speeds and you get used to engaging the muscles exactly how you need to.
What was invaluable to me was exactly that matching up of muscles and brain - knowing I was doing what I thought I was doing. As people mention above, releasing is what many people have more trouble with. Anyway, the progression went from lying down doing the exercises, to sitting up, to standing, to standing and moving (like taking lunges or jumping side to side) while also contracting and releasing when you intend to and with the strength you intend to. It was absolutely worthwhile and effective. I think I went once a week for two months, with exercises in-between. However, one thing my PT said was "Don't overdo it!" Many people do kegels too much and without focusing on the release, and then have no power when needed. Knowing what I now do about PF PT, I'm an evangelist. I have exercises I still do when I need to, that are more complicated than just "kegels".
Even if you aren't interested in surgery, it might be really useful to see a uro-gynecologist and talk through the options with them, and what the likely progression is of your incontinence for all the various options. I assumed my issue could be handled by a pessary but learned it could not be. I also learned that no amount of PT was going to fix the structural issues and that it would get worse. Understanding the options and trajectories was helpful for me.
That's what brings me to using the Perifit, because my pelvic and abdominal muscles are weak after surgery. I approached a PF PT looking to do core work so I could go back to strength training safely and she recommended the Perifit to me after hearing I had a good foundation for doing the work on my own. She has used it herself and with other clients.
So far I like it. It has the same focus on biofeedback that I found most helpful. You insert it and calibrate (it also measures different muscle groups, deeper vs. shallow), and then it gives you game-like tasks that you accomplish by contracting and releasing. (Usually the visuals are things like birds or planes where you have to control the altitude.) The app doesn't seem to store/share personal data, but does store your scores so you can progress. Again, the biggest help for me is reconnecting the lines of communication between my brain and my muscles, and having the device serve up a variety of patterns so I'm not just mindlessly contracting and releasing. The instructions also suggest the progression of starting lying down, then moving to sitting, standing, etc. (p.s. size-wise the Perifit is dildo sized vs. the bullet size of the PT wand.)
posted by cocoagirl at 11:17 AM on January 26, 2023 [2 favorites]
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posted by plonkee at 12:23 AM on January 25, 2023 [6 favorites]