ASK SARAH From our GP
Q I’ve had stress incontinence for years and finally found the courage to see my GP. She wants me to try physiotherapy instead of going for surgery. Will it work?
A First, well done for seeking help – stress incontinence affects millions of women, and yet too often they suffer in silence because of embarrassment or they think nothing can be done. Pelvic floor strengthening exercises, done regularly and properly (it can be hard to find the right muscles to exercise), are always my first recommendation. They can improve or resolve symptoms in about three in five women.
Most areas of the country have specialist continence services where you can be assessed and offered treatment. The physiotherapy team can help you locate and exercise your pelvic floor muscles, sometimes using a technique called biofeedback. A small device is inserted into your vagina while you squeeze your pelvic floor. When you use the correct muscles, the device alerts you.
I’ve had concerns for some years about vaginal mesh, a procedure for womb prolapse or female incontinence that involves placing a synthetic mesh below the vagina walls to support structures in the pelvis or womb. It has become clear that mesh can erode surrounding tissues, leading to excruciating pain, incontinence and sexual problems. Worse, the mesh becomes interwoven with the body’s tissues, so removing it is very difficult and can lead to further problems. The complications affect only a minority, but their impact is vast. I’m delighted that NHS England has announced a virtually complete ban on all mesh procedures while a full review is carried out.
If physiotherapy doesn’t help, your GP can refer you to a specialist who will discuss alternatives to mesh, such as a hitch and stitch procedure to reinforce pelvic structures that support your bladder.