What is stress urinary incontinence?
Stress urinary incontinence is a medical condition causing individuals to leak urine involuntarily when they do ordinary daily activities like coughing, standing up, lifting, sneezing, or exercising. Any motion that increases pressure on the bladder can cause involuntary urine loss, especially if the bladder is full. However, unlike urinary incontinence caused by an overactive bladder, stress urinary incontinence occurs without having an urge to urinate, or having an overly full feeling.
What Causes Stress Urinary Incontinence?
This condition is caused by weakened pelvic floor and weak urinary sphincter muscles. Weakened muscles can no longer keep the urethra tube closed when pressured, therefore causing urine leakage with activity. Muscles can become weak from:
Childbirth: nerve and tissue damage during vaginal delivery is common and a frequent contributor to stress incontinence.
Prostate surgery: surgery to treat prostate cancer often weakens the sphincter muscles.
High-impact exercise: can stretch and stress these muscles.
Illnesses: hormonal deficiencies can cause muscles to weaken and diseases that cause chronic sneezing and coughing can lead to increased leakage.
Excessive caffeine or alcohol consumption may cause increased urination and add to the problem.
Who is at Risk for Stress Urinary Incontinence?
This condition is a surprisingly common medical condition. In fact, one out of every three women will experience stress urinary incontinence at some point in life and many men also experience the problem. Risk factors include:
- Advanced Age: a general weakening of muscles occurs in aging and can make a person more susceptible.
- Body Weight: because excess weight puts pressure on the abdomen and pelvic muscles, overweight or obese individuals have significantly more problems with stress urinary incontinence.
- Pelvic Surgery: any surgery in the pelvic region can frequently damage or weaken the muscles of that area. Women who have had hysterectomies and men who have had prostate cancer surgeries are particularly vulnerable.
- Stressful Childbirth Deliveries: women who have had long second stages of labor when they are pushing, multiple vaginal deliveries, or forceps deliveries often have a greater risk of pelvic muscle damage.
Complications from Stress Urinary Incontinence
Unfortunately, embarrassment can prevent people from discussing the problem of urinary incontinence with health care providers. Therefore, it can be helpful for medical personnel to recognize complications which might be presenting symptoms of the condition, such as
- Skin Rashes or Irritations: urine irritates the skin and can cause rashes or even ulcers that may have difficulty healing. Incontinence underwear, pads, and moisture barrier creams can help.
- Emotional Distress: feeling stressed or even developing depression can happen when stress urinary incontinence disrupts work, daily activities or even a person's sex life.
- Mixed Incontinence:people with urge incontinence caused by involuntary contraction of their bladder muscles may also be experiencing involuntary incontinence caused by weak muscles.
Medical Testing for Stress Urinary Incontinence
In order to diagnose the condition, health providers can look for clues in a medical history, physical exam, urine sample testing for infection, and urinary stress tests which measure urine loss during coughing. Patients might be asked to keep a bladder diary to keep track of leakage events. Other less frequent tests can include bladder pressure tests through cytometry, pressure flow studies, video urodynamic images of the bladder, and ultrasound scans of post-void residual bladder function.
Non-Surgical Stress Urinary Incontinence Management
Using absorbent pads, reducing weight, reducing caffeine consumption, and controlling coughing can all be non-surgical methods to improve urinary continence. In addition, because weak muscles are the primary cause, patients can frequently achieve significant improvement by strengthening these muscles. Health care providers can assist in this behavioral treatment by teaching patients to locate and control these muscles through pelvic floor training which is sometimes called Kegel exercises.
Pelvic Floor Training
This behavioral therapy helps individuals locate the correct muscles by telling them to squeeze the muscles of the anus so that they feel a "pull" on the anus. They can also learn to locate the correct muscles by practicing stopping the flow of urine. If individuals have trouble locating the correct muscles, biofeedback, electrical stimulation or a physical therapist specializing in pelvic floor rehabilitation can be of assistance. After locating the muscles, individuals should practice squeezing and releasing, increasing the time they hold the squeeze until they can do it for a count of 10 for 10-15 times, three times a day.
Prognosis for Stress Urinary Incontinence
Generally, improvement in stress urinary incontinence is seen after six weeks of pelvic floor muscle training with significant improvement after three months. If non-surgical methods of management do not work and stress urinary incontinence is significantly impeding daily activities, health care providers may consider suggesting surgical solutions such as urethral bulking, slings or bladder neck suspension.
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.