Free to laugh, sneeze, and jump after treatments for leaky bladder

After 20 years of living with a leaky bladder, Pam Cobb is finally free from trickles, drips, splashes, and spurts.

“Every time I would jog, jump, cough, sneeze, or laugh, there was a chance I would leak," said Cobb, 49. “It started after my first baby and progressed over time.”

Like many women, she accepted the leaking as normal and found creative ways to power on. “I’m a long-distance runner and was able to work it out,” Cobb said. Unfortunately, over time, her workarounds became less reliable.

“When my boys were young, we would go to trampoline parks, and I would have to wear a pad. It was uncomfortable, and no matter how empty I thought my bladder would be, jumping was a no-go,” she said.

Her wake-up call came during a wedding last year when she realized she couldn’t dance without leaking.

The first step

Cobb sought help from Alex J. Soriano, MD, a double board certified urogynecologist, pelvic reconstructive surgeon, and menopause specialist at Penn Medicine Doylestown Health Urology.

“Urinary incontinence arises from various causes, and for Pam, it was a result of both stress incontinence and an overactive bladder,” Soriano explained.

She’s not alone, a study in Female Pelvic Medicine and Reconstructive Surgery reports that incontinence is prevalent among women, affecting 61.8 percent of women over 20 and 75 percent over 65.

Understanding incontinence

According to Soriano, stress incontinence was Cobb’s primary symptom, resulting from a weakening of the pelvic ligaments and muscles that support the bladder and urethra.

Women commonly experience stress incontinence as they start menopause. Still, the most significant risk factor is childbirth with a vaginal delivery. Other causes include obesity, diabetes, genetics, and previous pelvic surgery.

More common with aging, an overactive bladder pushes out urine involuntarily, leading to frequent urination, a sudden urge to go, and occasional leaks.

Discussing treatment options

Urogynecology offers personalized treatments to address physical and hormonal causes of urinary incontinence, aiming to improve women's quality of life at any stage.

“I felt very comfortable with Dr. Soriano. He spent time discussing surgical and non-surgical options. I didn’t want to be out of commission for long,” Cobb said.

“Dropping estrogen levels are a major factor in female incontinence and can also lead to vaginal dryness, painful intercourse, recurrent infections, and burning during urination,” Soriano said.

Cobb started vaginal estrogen cream, a localized treatment that helps strengthen the urethra. “The medication is absorbed through estrogen receptors at the bladder’s base, so this is not hormone replacement therapy,” Soriano said. Applied twice weekly, the cream is effective for women of all ages, including perimenopausal women, breastfeeding mothers, and those who have recently given birth.

Soriano works closely with Penn Medicine Doylestown Health’s pelvic floor therapists, who helped Cobb to strengthen her pelvic floor.

“While not a cure, pelvic floor exercises and physical therapy improve muscle strength and reduce stress incontinence symptoms by 60 percent to 80 percent,” he said. Insertable devices, such as incontinence rings or pessaries, offer extra support during activities.

“Pam was interested in long-term relief, so she opted for a mid-urethral mesh sling, the gold standard of surgical solutions for stress incontinence, with a 95 percent success rate,” Soriano said.

Soriano placed a small mesh strip under the urethra to prevent leaks during activities. This outpatient procedure, performed through a tiny vaginal incision, requires six weeks of recovery. During this time, Cobb could walk but had to avoid lifting over 10 pounds.

Getting her life back

“I had slight cramping for a day or two, and within five days I felt fantastic,” said Cobb, who got the go-ahead to add hills to her walk at her two-week checkup.

“Then at my six-week visit, Dr. Soriano said I had healed perfectly,” she said. “He told me, ‘Go forth and exercise!’”

“Highly effective options such as pelvic floor therapy can relieve symptoms, but are not a cure. For Pam, a combination of topical estrogen cream and the mesh sling resolved both her stress incontinence and overactive bladder,” Soriano said.

Cobb is back to her active lifestyle—doing yoga, barre, and jumping on the trampoline—without leaks!

“I’m thrilled with the results,” Cobb said. “My only regret is that I didn’t do this sooner.”