Do You Pee When You Sneeze?
Leaking when you sneeze, run, bear down, stand up, or clear your throat is a treatable problem, and you have options. Bulkamid is one particularly appealing option within that spectrum.
Are you a woman over 40 who gets nervous when she sneezes? Or coughs, laughs, exercises, jumps, lifts, or even just changes positions?
Stress urinary incontinence happens when pressure inside the abdomen rises. Any of the activities just listed can cause that pressure. The problem is generally that the urethral closure mechanism can’t generate enough resistance to keep urine in when abdominal pressure suddenly rises. Pregnancy, aging, hormone fluctuations, pelvic floor dysfunction, and certain neurologic or connective-tissue conditions can affect the muscles and tissues that help the urethra close tightly.
Some of the most common treatments for dealing with this type of incontinence are pelvic floor muscle training (PFMT), continence pessaries, vaginal inserts or devices, midurethral slings, or medication.
There’s also urethral bulking therapy with agents like Bulkamid. Where surgical procedures, mechanical devices, and conservative therapies provide support for the urethra, Bulkamid adds volume to the urethral wall to improve closure.
What is Bulkamid?
Bulkamid is a 97.5% water and 2.5% cross-linked polyacrylamide hydrogel. In other words, it’s a water-based gel that stays where it is injected rather than dispersing through the surrounding tissue.
A physician injects it into the urethral wall, creating several small “cushions” around the urethra. The cushions increase the bulk of the urethral wall and improve coaptation (the ability of the urethral walls to come together and resist leakage). The procedure is typically performed through a cystoscope, with the clinician watching the urethra directly while placing the injections. The goal is essentially to make the urethral outlet a little more resistant to sudden pressure increases.
How Effective is Bulkamid?
Studies of Bulkamid have found that many women experience meaningful improvement in stress urinary incontinence, although results vary depending on the study and how success is measured.
In one study of 357 women, 52% reported improvement and 30% reported no leakage after about two and a half years. Nearly half of the women reported a satisfaction score of 8 or higher out of 10¹. In a randomized controlled trial, 77% of women treated with polyacrylamide hydrogel considered themselves “cured” or improved after 12 months.² They also reported durable effects up to seven years later. In yet another trial, almost 92% of women reported the same thing: that either the incontinence was no longer an issue or it had remarkably improved.²
Different success rates show that there isn’t one treatment that works the same way for every woman, and someone doesn’t necessarily have to choose between PFMT and Bulkamid. Pelvic floor therapy, behavioral changes, devices, and procedures can sometimes be used together. Bulkamid can also be used as a secondary treatment for women who continue to experience leakage after another intervention. There is more than one way to treat stress urinary incontinence.
Why Would Someone Choose Bulkamid?
Bulkamid can be attractive to someone who:
- wants to avoid synthetic mesh
- doesn’t want a more invasive sling operation
- wants a relatively quick procedure
- wants to minimize recovery time
- has concerns about permanent surgical implants
- hasn’t gotten enough relief from conservative treatments
The injections are quick and typically require less recovery than traditional incontinence surgery. However, the trade-off is that its effectiveness may not be as durable as a sling. Also, some women may need a repeat injection or another treatment if leakage persists or returns over time.
Ultimately, choosing a treatment for stress urinary incontinence depends on the severity and cause of the leakage, previous treatments, and personal preferences. For some women, Bulkamid is a middle ground: more intervention than pelvic floor exercises or a pessary, but less invasive than a sling.
If stress urinary incontinence is making you think twice before you sneeze, laugh, exercise, or leave the house, call Georgia Urology and schedule a consultation with one of our Center of Excellence “Top Docs.” There are a number of therapies and combinations of therapies that can help you enjoy life without having to wear pads or worry about an accident. There are options. Different women need different approaches.
References:
- Osse, N. J. E., Koopman, L. S., Engberts, M. K., Blanker, M. H., & van Eijndhoven, H. W. F. (2024). Mid- to long-term results of Polyacrylamide Hydrogel (Bulkamid®) as recourse for female stress urinary incontinence. Continence, 10. https://doi.org/10.1016/j.cont.2024.101219.
- Itkonen Freitas, A. M., Mentula, M., Rahkola-Soisalo, P., Tulokas, S., & Mikkola, T. S. (2020). Tension-Free Vaginal Tape Surgery versus Polyacrylamide Hydrogel Injection for Primary Stress Urinary Incontinence: A Randomized Clinical Trial. The Journal of urology, 203(2), 372–378. https://doi.org/10.1097/JU.0000000000000517.
