Stress Urinary Incontinence

Urinary incontinence is the loss of the ability to control the bladder, leading to urine leakage. Stress urinary incontinence is a type of urinary incontinence in which urine leaks when there is excess pressure on the bladder due to certain movements or activities. These activities include coughing, laughing, sneezing, running, lifting weights, and others. It is important to note that this type of incontinence is not related to psychological stress.

What are the risk factors for stress urinary incontinence?

Anyone can experience urinary incontinence, but there are certain factors that increase the likelihood of developing this type of incontinence, including:

Gender, with women being more likely to experience it than men. Estimates suggest that half of women over the age of 65 suffer from stress urinary incontinence.
Pregnancy and childbirth (especially vaginal delivery).
Menopause.
Nerve injuries in the pelvic area or lower back.
Obesity.
Chronic cough.
Diabetes.

Diagnosis of Stress Urinary Incontinence

The diagnosis of stress urinary incontinence is usually made through several steps performed by the doctor to determine the exact cause of this type of incontinence. These steps include:

Medical history and physical examination

The doctor starts by reviewing the patient’s medical history, including any symptoms that have been observed, as well as factors that may contribute to the development of incontinence, such as age, previous pregnancies, or surgeries.

During the physical exam, the doctor may ask the patient to perform certain activities like coughing or sneezing to see if it causes urine leakage.

Urine tests

A urine test may be done to check for any infections, blood, or other substances that may indicate other urinary tract problems.

Urodynamics Study

This test helps measure bladder pressure and determine how the bladder functions during urination.

Imaging tests

These may include X-rays or ultrasound to monitor the bladder and surrounding tissues and ensure there are no structural issues.

Treatment of Stress Urinary Incontinence

Treatment depends on the severity of symptoms, the patient’s overall health, and the factors that may contribute to the issue. Treatments vary from lifestyle changes to medical and surgical procedures. These treatment options can be summarized as follows:

Lifestyle Modifications

These include:

Maintaining a healthy weight: Excess weight puts additional pressure on the bladder, so weight loss can help reduce the symptoms of stress urinary incontinence.
Dietary changes: Reducing the intake of caffeine, alcohol, and foods that may irritate the bladder can help relieve symptoms. It is also recommended to reduce fluid intake before bedtime to avoid frequent nighttime urination.
Scheduled voiding: Establishing specific times to urinate.

Pelvic Floor Exercises (Kegel Exercises)

Kegel exercises aim to strengthen the pelvic floor muscles. These exercises help improve bladder control and reduce urinary incontinence issues, as well as increase strength and flexibility in the pelvic area.

Steps for performing pelvic floor exercises include:

Over time, you can increase the duration of the contraction to 10 seconds. With regular practice, you will notice improvements in strength and control of the pelvic floor muscles.
Identifying the muscles: The first step is identifying the muscles that need strengthening. This can be done by trying to stop urination midstream. The muscles that feel active when trying to stop urinating are the pelvic floor muscles targeted in Kegel exercises.
Performing the exercise: Tighten the pelvic floor muscles (as if trying to stop urinating) and hold for 3 to 5 seconds.
Relax completely for 3 to 5 seconds.
Repeat the process 10 to 15 times in one set. Aim for 3 sets per day.

Surgical Treatment

Several surgical options are available, the most important being:

Sling surgery

This is an effective treatment for stress urinary incontinence. It involves placing tape behind the urethra to support it, which helps prevent urine leakage, especially during coughing or sneezing.

Burch Colposuspension

In certain cases, abdominal surgery may be required to treat stress urinary incontinence. It can be performed through an abdominal incision or laparoscopically.

References:

Stress incontinence. (2024, September 9). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22262-stress-incontinence
Stress incontinence. (2024a, July 14). Yale Medicine. https://www.yalemedicine.org/conditions/stress-incontinence
Stress incontinence – Diagnosis and treatment – Mayo Clinic. (n.d.). https://www.mayoclinic.org/diseases-conditions/stress-incontinence/diagnosis-treatment/drc-20355732

Stress Urinary Incontinence