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Stress incontinence is urinary leakage that occurs as a result of sudden pressure on the lower abdominal muscles, often caused by coughing, laughing, lifting, or exercise. Many women experience stress incontinence, particularly after menopause, but it can also occur when pelvic muscles have been weakened by childbirth or abdominal surgery.

Due to embarrassment, women often don't seek medical advice for this common problem, but there are a number of effective treatments:

• Kegel exercises: These exercises can strengthen the muscles that control urine flow. They involve squeezing the pelvic muscles, holding the tension for a count of 10, and relaxing for a count of 10. Repeat 20 times, three to four times a day. A study published in the November 2004 issue of the American Journal of Obstetrics and Gynecology showed that Kegel exercises work best for women who don't need to wear a protective garment, don't leak at first cough, and aren't incontinent daily. They were least effective for women who reported two or more leakages daily, had used psychiatric drugs long-term, and leaked at first cough.
• Biofeedback: This training teaches you to use signals from your body to help control symptoms. To find a therapist qualified to treat stress incontinence with biofeedback, contact the Biofeedback Certification Institute of America (BCIAC) or visit: www.bcia.org.
• Electrical stimulation: Here, electrodes are temporarily placed in the vagina to stimulate and stabilize the urethral muscles that control urine flow. In addition, a number of minor surgical procedures can help. A study published in the December 2004 issue of Obstetrics and Gynecology described a new method that involves implanting a polypropylene tape around the mid-urethra through a small vaginal incision. This can be done on an outpatient basis. Researchers in Finland reported that of 64 women treated, the overall cure rate was 81 percent and the tape remained effective seven years after being implanted.

Another new procedure reported at a November 2004 meeting of the Radiological Society of North America involved transplanting women's stem cells into the urethra to restore muscle mass and contractility. Researchers from Austria reported on a small study involving only 20 women. The outpatient procedure takes 15 to 20 minutes, and women notice results within 24 hours. The stem cells are collected from blood, cultured in the lab for six weeks, and then injected.

If embarrassment is preventing you from discussing stress incontinence with your physician, please know that millions of women suffer from this problem and that help is available.

Andrew Weil, M.D.