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Relief for Exercise Incontinence

THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 1 - JANUARY 96


Stress incontinence often puts a damper on a woman's resolve to exercise. Up to a third of women—even young, conditioned athletes—experience stress incontinence (1). Treatment options have included tampons, pessaries, diaphragms, and, for severe cases, surgery. The bladder neck support prosthesis (BNSP) is a new option.

A study (1) on the effectiveness of two incontinence options—tampons and pessaries—recently came out in favor of tampons. The researchers found that 8 of 14 women with mild incontinence (less than 15 g of urine loss) remained dry while wearing a tampon during aerobic exercise, while a standard pessary kept only 5 of 14 women dry. Urine loss was measured by weighing an absorbent pad before and after exercise.

The tampon is worn during exercise or other activities that produce stress incontinence, says Ingrid Nygaard, MD, the study's author and assistant professor in the Department of Obstetrics and Gynecology at the University of Iowa College of Medicine in Iowa City. Tampons have no side effects when worn for less than a day, she says. Nygaard advises patients to moisten the tip of the tampon with water beforehand to make insertion and removal more comfortable.

Most women, and even some gynecologists, have never heard of pessaries, Nygaard says. There are many types of pessaries: The ones specifically designed to treat stress incontinence resemble a diaphragm but have a protrusion on the ring that helps elevate the urethra, thus blocking urine leakage. When worn only for short periods of time during activities that produce incontinence, pessaries produce no side effects and do not decondition pelvic floor muscles, Nygaard says.

A new vaginal device designed especially for active women debuted in October. The flexible, ring-shaped BNSP has two blunt prongs on one end that laterally support the urethra. The BNSP (Johnson and Johnson Medical, Inc, Arlington, Texas) rests on the pelvic floor muscles and reinforces their function during exercise. "This is the same thing we accomplish with surgery," says urogynecologist Willy Davila, MD, of the Colorado Gynecology and Continence Center in Denver. When tested on runners, hikers, and other active women, the BNSP kept 24 of 30 patients dry; 6 were improved but still had mild incontinence (2). Benefits were greatest in those who had severe incontinence. All participants rated the device satisfactory.

To provide a custom fit, BNSPs come in 25 sizes, varying in ring size and prong length. The BNSP appears to be relatively free of side effects, says Davila. One patient in the study developed a bladder infection; however, he says bladder infections are not unusual in patients who have stress incontinence. Pelvic floor muscle deconditioning is not an issue, Davila says. In fact, he says muscle function seems to improve: Pelvic floor contractions during activity are partially responsible for the device's support function.

Physicians can routinely help women open up about their problems with incontinence by telling patients that many active women notice urine leakage while exercising, says Nygaard. Advising women about simple, nonsurgical treatments such as tampons, pessaries, and pelvic floor exercises can minimize incontinence and keep women exercising, she says.

A traditional pessary costs about $50, and the BNSP costs about $300, says Nygaard. Some active women report that the BNSP is more comfortable than the traditional pessary, says Davila. "The BNSP fits in loosely and is designed to be dynamic; it moves with the woman," he says. "A traditional pessary fits in tightly and supports prolapsed tissues." However, Nygaard says many of her patients who are runners have been satisfied with comfort of traditional pessaries.

References

  1. Nygaard I: Prevention of exercise incontinence with mechanical devices. J Reprod Med 1995;40(2):89-94
  2. Davila GW, Ostermann KV: The bladder neck support prosthesis: a nonsurgical approach to stress incontinence in adult women. Am J Obstet Gynecol 1994;171(1):206-211

Carol Potera
Great Falls, Montana


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