Stressed About Stress Incontinence? Don’t Be!

Apr 3, 2018

Mom and daughter laughingMost women can remember the first time it happened—that mortifying “uh-oh” moment when an unexpected and uncontrollable trickle of urine ran down their leg or wet their clothes. It may have happened when they were laughing with friends, trying to suppress a cough at work, exercising at the gym, or just playing in the backyard with their kids or dog. Wherever it happened, it marked the unwanted beginning of their silent, embarrassing struggle with stress incontinence.

Although nearly one-fourth of all women over the age of 17 are affected by stress incontinence, less than half of them talk with a doctor about it.

“It takes a lot of courage to talk with a doctor about this,” says Geoffrey Nuss, MD, a board-certified urologist with USMD. “I don’t take that lightly. In my practice, I understand that this can be a very sensitive problem and try to honor that. One of the first things I tell a woman is that they’re not alone. Stress incontinence is far more common than they think.”

What causes stress incontinence?

The natural aging process and child birth are the biggest contributors to stress incontinence. As women grow older, their pelvic floor can weaken, leading to urinary issues. During pregnancy, as the baby grows and expands the pelvis, it not only puts pressure on the bladder and urethra, but also stretches the support structures that hold them in place. While a woman’s post-pregnancy body recovers, the stretched-out support structures often don’t return to their pre-baby state—which makes women susceptible to incontinence. Of course, it’s no surprise that unwanted urine leaks can take an unpleasant toll on a woman’s quality of life.

Pads aren’t a longtime solution.

“Many patients who come to me have already tried pads and disposable underwear,” says Dr. Nuss. “It’s

a natural first step. The problem is embarrassing, so they try to solve it on their own. The easiest way to do that is to use disposables because they’re available and relatively inexpensive. Over time, though, the cost adds up. Some women spend $20 to $30 a week on pads. If you buy them on a regular basis they become quite expensive. If you’re on a fixed income—especially if you’re retired and on social security—that can add up. Along with the cost, pads don’t address the sense of shame or discomfort women often feel with incontinence.  Not only is a wet pad uncomfortable, it causes a bad odor and can be irritating to the skin. Most of the solutions a urologist can offer are long-term, if not permanent. My goal is always to fix a problem instead of simply putting a band-aid on it.”

Slings stop unwanted leaking.

Rather than be embarrassed and inconvenienced by stress incontinence, you can actually live without leaks thanks to a proven outpatient procedure that has been performed for more than 15 years now. “The sling procedure takes about 15 to 20 minutes,” Dr. Nuss explains. “During the procedure, I make a small incision just underneath the urethra through the vagina. The small incision allows the placement of a small piece of mesh tape underneath the urethra to recreate the support structure that’s been lost due to aging or childbirth.”

The mesh strip actually acts like a small hammock that cradles the urethra. With the sling procedure, you go home the same day, and recovery is fairly easy—about four weeks before you’re back full strength to all your pre-procedure activities.

“The sling is usually a very long term or permanent solution,” Dr. Nuss adds. “For many women, it can be life changing.”

Dr. Nuss has performed the sling procedure on women in their 30s, 40s, and into their 80s. “No woman is too young or too old for this procedure,” he says.

A woman in her late thirties recently came to Dr. Nuss. “She is a professional woman with two children and a career. She’s physically fit and is very active, yet stress incontinence was interfering with her lifestyle. She was leaking two or three times a day. After some testing and counseling, we decided the sling was a good option for her. Now she basically doesn’t have any leakage. She no longer has to worry about having embarrassing moments. She can be active with her kids, go the gym, perform at work, and do all the social activities she enjoys without worrying about wetting herself.”

For a 78-year-old woman who’d grown increasingly homebound due to uncontrollable leaking, the sling also proved to be a great solution. “She was going through several pads a day, and it was embarrassing in social situations,” says Dr. Nuss. “After evaluation and counseling, we decided a sling could really help. Now she’s dry and doesn’t have to stay close to home to change her pads. She’s more active and can go places again because she doesn’t have to worry about being embarrassed.”

Ladies, don’t live with leaks!

“There are very effective treatments for stress incontinence,” says Dr. Nuss. “That’s why I encourage women to find a care provider who is compassionate and not only understands the disease process, but that it can have a significant impact on their emotional and social wellbeing. When I talk with a woman about incontinence, I try to understand how the problem affects her, and then recommend a solution that’s not only medically appropriate, but fits her lifestyle, too. Sometimes that means we don’t do surgery right away and try other treatments first. Treatment is never a one-size-fits-all solution for my patients because I realize it’s important for people to have direct agency and control in the way they’re treated.”

If you suffer from stress incontinence, Dr. Nuss can help. To schedule a consultation, please call 817.784.8268 today. To learn more about Dr. Nuss, please visit

Dr. Geoffrey Nuss, urologist, USMD Health System

Dr. Geoffrey Nuss, urologist, USMD Health System