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Medical Edge Newspaper Column from Mayo Clinic

TREATING POST-PREGNANCY URINARY LEAKAGE

DEAR MAYO CLINIC: More than two years after giving birth, I still have mild urinary leakage. A gynecologist told me this is a fairly common result of delivery and acted like it’s no big deal because it’s only two ounces. I’ve been doing Kegel exercises. The doctor said surgery was only an option for older women. Are there any other treatment options?

ANSWER: Urinary incontinence isn’t unusual after a vaginal delivery. But for many women, it’s temporary. Once you start menstruating and stop breast-feeding, and hormones return to pre-pregnancy levels, the problem often goes away.

At two years after the birth, that isn’t likely your situation. I’d suggest you seek medical help. You have several treatment options, including:

— More Kegel exercises. This exercise, where you contract the pelvic floor, is generally helpful. But if you are not doing the exercise correctly, it can make symptoms worse.

Check with your care provider or a physical therapist to help make sure you’re benefiting from your exercise efforts. Using vaginal weights or cones could help, too. You place a small weight or cone in the vagina while you do Kegel exercises. A correct contraction holds it in place. As the muscle gets stronger, you can increase the weight.

— Estrogen supplements. After giving birth, some women have an estrogen deficiency that seems to contribute to incontinence. Estrogen supplements given vaginally, in the form of creams, pills or rings, could reduce your symptoms.

— Urethral inserts. If you leak only during specific activities, then a urethral insert may be an option (it may also be an option if you have leakage and want to have more children). You place a thin insert, or plug, in the urethra to prevent leakage (a "cork" in the bottle analogy). However, if you leak more often, then surgery might be a better option as the urethral insert has a slight risk of bladder infection associated with it.

— Surgery. Surgery is an effective option for stress incontinence. There are several surgical options — but only if you have completed childbearing. Current data suggests that 75 to 90 percent of women no longer experience stress incontinence after surgery. Childbirth after surgery could undo the benefits.

Don’t give up. Talk to a care provider, because there are options that could treat your incontinence.

— John Gebhart, M.D., Urogynecology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of Urinary Incontinence
Appointment Information
More Information on Urinary Incontinence

DEAR MAYO CLINIC: Tell me about fetal umbilical cord-blood storage. How is it done and do you recommend it?

ANSWER: Umbilical cord blood is the blood that remains in the baby’s umbilical cord after it has been cut. It’s usually thrown away.

You can contract with private companies to store umbilical cord blood for years in the unlikely event that your child or another family member could benefit from the stem cells contained in the blood. Researchers have found that cord-blood stem cells sometimes can be used instead of bone marrow stem cells to treat leukemia and some other serious illnesses.

Donating doesn’t pose any risks and shouldn’t change the birth experience. The blood is packaged in a kit provided by the storage company.

You might consider banking the cord blood as extra insurance. If the new baby or another family member has the misfortune to have such a serious illness occur later in life, the cord blood could be helpful.

But the chance of needing the cord blood is extremely low. It is more of a financial decision than a health issue. You would be paying for defense against a very unlikely event. Collection and processing fees can be $1,000 or more. There are also annual storage fees.

The American Academy of Pediatrics doesn’t recommend private storage as biological insurance unless there’s a family member with a current or potential need for a stem cell transplant. I don’t recommend it, either. This service isn’t available at Mayo Clinic.

If you can afford to defend your family against extremely remote risks, banking umbilical cord blood is an option. If you proceed, check out the company carefully. It’s a new, mostly unregulated industry.

— Roger Harms, M.D., Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.