What is Stress Incontinence?
Stress incontinence is the involuntary loss of urine during activities that exert stress on the bladder, such as running, straining, lifting, exercises, coughing, laughing, and sneezing. It usually occurs when the muscles of the pelvic floor that support the urethra and the muscles of the urinary sphincter that control urination become weakened.
What are the Causes of Stress Incontinence?
The pelvic floor muscles and urinary sphincter muscles can become weakened due to reasons such as:
- Childbirth, especially a vaginal delivery
- Pelvic surgery or radiation
- Obesity
- Chronic coughing or lifting
- Chronic constipation
- Lower back injuries or surgery
What are the Symptoms of Stress Incontinence?
Stress incontinence is characterized by a sudden loss of urine during activities such as:
- Laughing
- Coughing
- Sneezing
- Exercising
- Lifting something heavy
- Sexual intercourse
How is Stress Incontinence Diagnosed?
Your doctor will review your medical history and perform a physical exam, which may include a pelvic exam and a rectal exam. The other diagnostic tests include:
- Urine sample to detect traces of blood, infection, and other abnormalities
- Urinary stress test where your doctor observes urine loss when you cough or bend downwards
Bladder function tests may include:
- Pelvic ultrasound scan to measure the amount of residual urine in your bladder after you urinate.
- Multichannel Urodynamics: Pressures are measured as the bladder fills and empties by administering a sterile fluid into the bladder. During the test, bladder, urethral and abdominal pressures are measured on a computer and the obtained tracings will help achieve an accurate diagnosis.
- Cystoscopy: In this test, a scope is inserted into your bladder to detect any blockages or other abnormalities in the bladder and urethra.
What are the Treatment Options for Stress Incontinence?
Stress incontinence can be treated through a combination of approaches. These include:
Lifestyle Changes/Behavioral and Physical Therapy
Behavioral therapy or lifestyle changes include:
- Regular Kegel exercises to strengthen pelvic floor muscles and urinary sphincter
- If you are unable to perform effective Kegel exercises, you may be referred to a trained Women’s Health Physical Therapist who has an expertise in teaching women how to perform proper pelvic floor muscle contractions.
- Consume a fiber-rich diet to avoid constipation
- Regulate your fluid consumption in terms of volume, frequency, and the time of consumption
- Avoid carbonated, caffeinated, and alcoholic beverages as they may irritate and affect the bladder function
- Quit smoking, shed excess weight, and treat chronic coughing
Medications
There is no specific FDA approved drug to treat stress incontinence in the United States.
Medical Devices
Medical devices are available that can be placed inside the body to help control stress incontinence. These include:
Vaginal Pessary
A specialized ring-shaped device for women that is inserted in the vagina and kept in place all day. Vaginal pessaries support the base of your bladder to prevent leakage of urine during physical activities and are useful for a prolapsed bladder. Vaginal pessaries are recommended if you do not want to undergo surgery. However, it has to be routinely removed and cleaned and your doctor will provide proper instructions to you.
Other vaginal Inserts
Regular menstrual tampons can be placed in the vagina in order to improve support of the urethra and prevent urine loss. They can only be left in place for short term usage.
Surgery
Surgery is recommended if conservative treatments do not provide symptomatic relief. The goal of surgery is to tighten the sphincter muscles or support the neck of the urinary bladder to relieve incontinence. The different surgical procedures are:
Sling Procedure
In this procedure, a person's own tissues, a synthetic mesh tape, or an animal graft tissue is used to create a hammock or sling to support the urethra. The synthetic tape TVT sling is the most commonly performed surgical treatment in women world-wide. It can be placed through a vaginal and 2 supra-pubic incisions, or simply through a vaginal incision. A small mesh tape such as an incontinence sling is readily incorporated into human tissue with minimal complications. Slings should not be confused with synthetic mesh sheets which were used in vaginal prolapse mesh kits and had recognized complications leading to their being pulled from the market.
Injection of Bulking Agents
Materials such as silicone or calcium gels are injected into tissues around the upper portion of the urethra to increase pressure around the urethra, thus improving closure of the urinary sphincter. These procedures are performed in the office with local anesthesia or the ambulatory surgery center with intravenous sedation.
Retropubic Colposuspension
This surgery can be performed laparoscopically or through an incision in your abdomen. In this procedure, the tissues near the neck of the bladder are sutured to ligaments along the pubic bone to lift and support the upper portion of the urethra.
