Urine Loss During Coughing or Lifting

QUESTION: I am frequently embarrassed when I lose my urine during a coughing
fit, or when I bend over to lift my grocery packages. I know this frequently
comes on in people my age, but I don't understand why, or if there is anything
I can really do to prevent it. Will you please help?
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ANSWER: I'll do all I can to help you, and then tell you where even more help
is waiting. Your condition is the most common cause of involuntary loss of
urine in women, and is called stress incontinence. It is provoked by almost
any action that causes sudden increases in the pressure in our abdomen, simple
things like sneezing, straining, lifting and of course, coughing. It is due
to the change in position of the tube leading from the bladder to the outside,
the urethra, which falls below its normal place behind the pelvic bone and can
no longer hold back the urine as it should when pressures suddenly increase.
It can also result from the relaxation of the muscles of the pelvic floor,
another result of the aging process. There are several strategies that may be
used to correct the problem and prevent your embarrassment. Sometimes simple
exercises to strengthen the muscles will suffice. (They are called Kegel's
exercises.) Medications to strengthen the actions of the muscles which keep
the urethra closed are available and frequently quite effective. Mechanical
devices, such as a pessary, can be used to restore the correct anatomical
position of the bladder outlet. Finally a surgical procedure may be necessary
to strengthen muscles and reposition the involved organs.