Stress Incontinence Symptoms and Treatment
Stress incontinence is the most common form of urinary incontinence and occurs when an individual has unintentional leakage of urine, usually after an activity that presses on the bladder. Because stress incontinence can occur after simply lifting something heavy, coughing, sneezing, exercising or even having sexual activity, this common medical condition can severely impact a patient's life and mental health.
Symptoms of Stress Incontinence
The main presenting symptom is unintentional bladder leakage. Usually, the leakage is a small amount, but sometimes, if the bladder is very full, the leakage may be larger. Unlike urge incontinence, stress incontinence does not involve a feeling of having to urinate.
When an individual has stress incontinence, leakage generally occurs when some activity presses on the bladder. While patients can learn to anticipate episodes of stress incontinence, they are not necessarily aware that the leakage will happen before it occurs.
Prevalence of Stress Incontinence
Normally, an adult can hold at least 2 cups (350-550ml) of urine in their bladder. However, when the two muscles that hold urine flow are weakened, the bladder may not be able to keep from leaking out urine when pressured. As many as 1 in 5 older women have stress incontinence to some degree because childbirth is a significant contributor to the weakening of these urinary control muscles. While much less frequent in men, stress incontinence can also affect men who have had trauma, neurological injury or prostate surgery.
Lifestyle Treatments for Stress Incontinence
Often, the following lifestyle changes can help ease the symptoms of urinary stress incontinence:
- Bladder Diary: keeping a diary of leakage episodes can help locate particular patterns in order to devise strategies to minimize irritations that lead to bladder leakage.
- Lose Weight: excess weight can cause pressure on weak muscles and increase stress incontinence. Losing weight can often create significant change in symptoms.
- Smoking Cessation: by quitting smoking, individuals can reduce their coughing, which can improve symptoms significantly.
- Change Fluid Consumption: sometimes changing the amount or timing of fluid consumption can aid in preventing leakage. Additionally, reducing or eliminating beverages with caffeine can improve symptoms because caffeine increases urination.
Pelvic Floor Exercises for Stress Incontinence
In addition to lifestyle changes, most medical professionals suggest behavioral therapy to strengthen the weak pelvic floor muscles. The most common kind of therapy is Kegel exercises which involve tightening the pelvic floor muscles, holding them tight and then releasing them. Over a period of time, the individual can increase the length of the exercises and the number of repetitions. If an individual is having difficulty locating the muscles, biofeedback, electrical stimulation, vaginal palpation (for women), or specially trained physical therapists can assist.
Device Treatments for Stress Incontinence
For women who have problems with leaking urine during high-impact exercises or another high-stress activity, special urinary control devices can be of assistance:
- Occlusive Devices: inserted into the urethra, urethral inserts and patches can absorb pressure from high impact activities. While somewhat uncomfortable and not safe for constant use, these devices can be helpful for some women who have problems only during exercise.
- Incontinence Pessary: Most useful for people who have pelvic organ prolapse, this device is inserted into the vagina and compresses the urethra closed. Pessaries come in different materials, shapes, and sizes and must be individually fitted. Unlike occlusive devices, a pessary can be worn as long as the woman wants, including 24 hours a day.
- Over-the-Counter, Disposable Pessary: These one-time use pessaries are not fitted exactly to the individual but can be easily obtained.
Surgical Treatments for Stress Incontinence
Surgical interventions aim to improve sphincter closure or support the bladder neck. These include:
- Bulking Agents: synthetic polysaccharides or gels that are injected into the upper part of the urethra to improve sphincter closure. This is relatively noninvasive but not a permanent repair. The injections can be repeated.
- Retropubic Colposuspension: sutures are used to lift and support tissues of bladder and urethra.
- Slings: in this common procedure for both men and women, a sling is made from the patient's own tissue, synthetic material, or animal tissue to be a hammock to support the urethra.
- Inflatable Artificial Sphincter: mostly used for men, this surgical device is a cuff which fits around the urethra and replaces the sphincter.
Treating Stress Incontinence
The first-line treatments for this condition are lifestyle changes and exercises to strengthen the pelvic floor muscles. Generally, over 50% of patients have significant improvement using these methods. The depression medicine Duloxetine is sometimes used to help muscles contract better and make Kegel exercises more effective. However, the improvement through lifestyle changes is gradual and takes time. Surgical treatments have possible complications but do offer a cure for some individuals.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of IncontinenceSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.