stress incontinence

I have a few specific questions about stress incontinence. Does it get worse or stay the same with menopause? I finally talked to my gynecologist about it who described the tests they do, etc., but said she wanted me to see a urologist to be sure I'm doing Kegel exercises correct and for biofeedback. I know that being overweight can contribute to SI but, and I know you may not be able to tell this, but since I'm 5'6" tall and weigh 186 wounds, would you consider that part of my problem? I've had SI for at least 3-4 years and I'm now 52 years old and premenopausal. I leak urine with harsh coughing, sneezing, laughing hard, heavy lifting and sometimes running. I've adjusted my lifestyle to try to live with this, no heavy lifting or running or laughing hard. Don't smoke so no chronic cough. If I'm alone and cough, etc., I cross my legs to stop the leak which sometimes works and sometimes doesn't. Since I don't leak urine on a daily basis, do you think it would still be worth the time, embarrassment, etc. to proceed with the urologist and all the tests? I do believe I'm doing Kegel exercises correct (but could be wrong) and I'm not doing them enough, but would the purchase of the "Kegelmaster" or similar exerciser to do Kegels be worth purchasing as I think it can be expensive? Can a neuromuscular problem be detected through testing for muscle tone of the pelvis muscles for SI? My sister had multiple sclerosis and SI associated with that but I have no problem like she did. Thank you so much for your kind help.

[Machelle Seibel, MD]

A. Stress incontinence is common, affecting about one third of women your age. Most are so embarrassed they wait 3 to 5 years to discuss it with their doctor. It can get worse with menopause.  If you are squeezing your bladder and rectal muscles so that you are stopping the flow of urine, you are doing it correctly. Just do the exercises ten times at least 6 times each day. It is muscle strengthening. If you do see a urologist, be sure it is one who treats this type of problem often. Many urologists specialize in prostate issues in men.  There are also Urogynecologists who specialize in your problem exactly.

There are some new treatments that use instruments placed into the vaginal canal and rectum along with a very mild electrical current to stimulate the muscles to work better. Eliminating spicy foods and caffeine can also reduce the problem as can emptying your bladder more often so there is less to spill when you cough or sneeze. But definitely go to see someone who deals with the problem. There is a lot that can be done to help you.
Machelle M. Seibel, MD