OVERVIEW
Urinary incontinence is the involuntary leakage of urine. Stress incontinence happens due to physical activity or increases in abdominal pressure (i.e. coughing, laughing, lifting).
Symptoms
Women with stress urinary incontinence may experience the following symptoms:
- Leakage with cough, sneeze, laugh, physical activity, intercourse
- A sudden and intense need to urinate
Causes
SUI is the most common occurring form of incontinence in women under the age of 60 and accounts for more than half the cases. One in every two to three women in the US experience SUI at some time in their lives. While pregnancy and childbirth head the list for causes of SUI, there are other health factors that may put you at risk, too. They include:
- Loss of pelvic muscle tone: this most often occurs with aging or childbirth
- Hysterectomy (or any other surgery that affects your pelvic floor)
- Nerve and muscle damage from childbirth or surgical trauma
- Obesity
- Menopause
- Chronic coughing due to smoking and lung disease
- Anatomical predisposition
- Repeated heavy lifting or high impact sports
Diagnosis/Evaluation
- What to know before your visit:
- During your visit, your doctor will ask you questions regarding your medical history and will perform an exam. It is helpful to keep a bladder diary for at least 3 days before seeing your physician. This will help inform your doctor of things like the severity of your bladder leaks and when you’re experiencing urine leaks, all of which may help to uncover any patterns happening with leakage. It is also helpful to bring a list of any medications, vitamins or other supplements you are taking to discuss with your doctor.
- Other tests that may be performed during or after your visit:
- Urinalysis: this evaluates for any blood in the urine or infection
- Post-void residual: The physician will often ask you to void and then check to make sure you are emptying your bladder.
- Cystoscopy: This is a procedure performed in the office where the physician inserts a small scope into the bladder
- Urodynamics: This is a test where a small tube is inserted into the urethra/bladder and another into the rectum to help measure the pressures in the bladder during urination.
Treatment
NON-SURGICAL TREATMENT
There are many treatment options as well as simple management techniques that can help you get your life back the way you want it.
- Loss of Excess Weight: Obesity is a risk factor in developing stress urinary incontinence due to the extra pressure placed on the pelvic floor and the bladder. Following a healthy diet and losing weight can help ease symptoms.
- Smoking Cessation: Smoking can cause or contribute to many diseases, it’s also a real factor in the development of SUI. All that coughing can put stress on your pelvic floor and that can lead to muscle weakness and leakage.
- Pelvic Floor Muscle Exercises: Kegel exercises help to strengthen the pelvic floor muscles so you’re able to better hold in urine. It’s a good idea to see a physical therapist to get a proper evaluation and to learn how to do these exercises correctly.
- Biofeedback: Biofeedback is often done in conjunction with kegels. A physical therapist may use a biofeedback instrument to measure your pelvic floor strength and monitor your improvement.
- Bladder Retraining: This involves timing your trips to the toilet and slowly increasing the length of time between each visit.
- Pelvic Floor Stimulation or E-Stim: This therapy delivers a small amount of electrical stimulation to the nerves and muscles of the pelvic floor and bladder to help them tighten or contract, thereby strengthening them.
- Injection Therapy: This technique uses a bulking agent that’s injected into the tissues around the urethra to help close the sphincter muscle without interfering with urination.
- Pessary: This is a ring-like device that your doctor will fit for you inside the urethra. The device helps to support the base of the bladder to prevent at most 50% of urine leaks. This is especially helpful for those who may have experienced a pelvic organ prolapse as it is not commonly used for stress incontinence alone.
- Topical Estrogen: Rarely prescribed to treat stress urinary incontinence due to low success rates, low dosage estrogen administered vaginally to gently lubricate the tissues of the vagina. Many clinicians observe improvement in symptoms of SUI in many women. This should not be confused with Hormone Replacement Therapy (HRT), which has been not proven to relieve incontinence in postmenopausal women.
SURGICAL TREATMENT
There has been a dramatic change in the number and types of operations for SUI performed in the last 25 years. The most successful revolve around an FDA approved “sling” that offers support and stability. Urethra bulking is also an option with varying degrees of success. You can read about the types of surgeries and what to expect on this dedicated page here.
Schedule an appointment with a MidLantic Urology physician near you today!