Free Women's Health Advice

Please know that our general columns cannot take the place of a visit to a qualified professional who can determine your exact situation and needs.

Archived Questions and Answers from
Debra L. Hill-Busselle, MD
On Women's Health Issues

• I am past childbearing age, do I need an OBGYN or can a Family Practice Physician do my Pap smear?

• I am 67 years old and have gone off my HRT. It seems I have less sensation with sex and that my vagina does not seem as firm with intercourse. Is this from stopping my estrogen?

• I am 16 years old and have a problem. Sometimes I notice an abnormal discharge. It looks like raw egg white. It does not have an odor. It goes away for a while, and then comes back again. What is wrong with me? I am afraid to ask my mom.

• I’m 58 years old and haven’t had a period for 5 years. I have a few hot flashes, but they are mild. I’ve never taken hormone therapy and seem to be doing fine without it. Sex, however, has become uncomfortable and at times it really hurts. Is this normal for someone my age?

• I’ve been having hot flashes and night sweats. My cycles are changing, I don’t sleep as well as I used to and I can be pretty moody at times. I am 46 years old and think I am too young to be in menopause. My friend, who is 39 years old, just stopped taking birth control pills three months ago. She is having hot flashes daily and has not had a period yet. She told me her mom went through menopause in her early 40s. Is she in menopause? Am I?

• I am 43 years old and try to exercise regularly. When I go to my aerobics class and we do jumping jacks, I leak urine! I am so embarrassed! What’s wrong with me?

• Should my daughter get the new HPV vaccine?

Questions & Answers

Question

I am 43 years old and try to exercise regularly. When I go to my aerobics class and we do jumping jacks, I leak urine! I am so embarrassed! What’s wrong with me?

Answer

It sounds like you have SUI (stress urinary incontinence). SUI is the most common cause of urinary leakage in women in their 40’s. As many as 40% of women over age 40 leak some urine with strenuous activities such as jumping jacks, jumping on a trampoline, horseback riding, high impact aerobics or even with coughing, sneezing or heavy lifting.

What is SUI? The urethra is the small tube that drains the bladder. Where the bladder and the urethra meet is the urethral sphincter. Normally this sphincter remains closed tight until we sit on the toilet and start urinating. With aging, weight gain, pelvic damage from childbirth, estrogen deficiency, or repetitive high impact activities, this sphincter weakens. Anytime there is increased pressure on the bladder and the pressure in the bladder is higher than the pressure generated by the sphincter, a small amount of urine leaks out.

Treatment Options: We need to try to either decrease pressure on the bladder or increase urethral sphincter strength or both!

1. To decrease pressure on the bladder, lose weight, quit smoking or control asthma to prevent chronic coughing, avoid high impact activities, and reduce heavy lifting.
   
2. To increase the strength of the urethral sphincter muscles, try contracting the pelvic floor muscles daily with Kegel Exercises. Do Kegels four times a day, for four times each episode, holding each for 10 seconds. Results are usually seen in 2-6 months.
   
3. Some medications can reduce SUI symptoms by increasing urethral pressure. None of these meds are FDA approved in the United States, but some are approved in Europe. Women take the medications daily and some report good results. If you are estrogen deficient, re-estrogenizing the vaginal tissues also helps reduce SUI.
   
4. A pessary is a ring device similar to a ‘heavy duty’ diaphragm that is fitted by your gynecologist. Pessaries are placed into the vagina and support the bladder neck and reduce SUI. They can be worn continuously or just inserted when needed (i.e. before an aerobics class).
   
5. Some patients wear pads, especially if they only leak during certain activities.
   
6. Surgery or ‘bladder tack up’ can help many women when conservative measures have failed to give them adequate results. Surgery is not 100% effective, and SUI can redevelop years after initial surgery.

Although leakage of urine is never ‘normal,’ it is very common. I guarantee that you are not the only woman in your exercise class who leaks urine during jumping jacks!