What is stress incontinence?
Stress incontinence is the inability to control your urge to urinate in certain circumstances. It’s a serious and embarrassing disorder and can lead to social isolation. Any pressure placed on the abdomen and bladder can lead to the involuntary loss of urine.
It’s important to remember that the term “stress” is used in a strictly physical sense when describing stress incontinence. It refers to excessive pressure on the bladder and not emotional stress.
An overactive bladder is a separate condition. In some cases, both overactive bladder and stress incontinence can occur, which is called mixed incontinence. Your Gynecologist can do tests to determine which is causing your incontinence.
Anatomy of the bladder
Your bladder is supported by a varied system of muscles:
- The sphincter encircles the urethra, the tube that carries urine outside of your body.
- The detrusor is the muscle of the bladder wall, which allows it to expand.
- The pelvic floor muscles help support the bladder and the urethra.
To hold urine inside your bladder without leakage, you need to be able to contract your sphincter. When your sphincter and pelvic muscles are weak, it’s more difficult to contract these muscles and the result is called as stress incontinence.
Stress incontinence symptoms
The main symptom of stress incontinence is the loss of bladder control during physical activity. You may experience a few drops of urine or a large, involuntary flow. This can happen while you are:
- laughing
- sneezing
- coughing
- jumping
- exercising
- doing heavy lifting
- engaging in sexual intercourse
Sometimes even standing up from a seated or reclining position can put additional pressure on your bladder and cause a leakage. Stress incontinence is unique for every individual. You may not show symptoms every time you participate in an activity, and the same activities that cause leakage for you may not affect another person with stress incontinence.
Who suffers from stress incontinence?
Women are twice as likely as men to suffer from involuntary leakage. The most common causes of stress incontinence among women are pregnancy and childbirth, especially having multiple vaginal deliveries. During pregnancy and childbirth, the sphincter and pelvic muscles stretch out and are weakened.
Older age and conditions that cause a chronic cough can also cause stress incontinence. This condition can also be a side effect of pelvic surgery.
Some women only suffer from stress incontinence during the week before they get their period. Various studies explain that estrogen drops during this phase of the menstrual cycle, which can weaken the urethra. This is not common though.
Other risk factors for stress incontinence include:
- smoking due to chronic cough
- any other condition associated with chronic cough
- excessive caffeine and alcohol use
- obesity
- constipation
- long-term participation in high-impact activities
Treatment
Your Gynecologist may recommend a combination of treatment strategies to end or lessen the number of incontinence episodes. If an underlying cause or contributing factor, such as a urinary tract infection, is identified, you’ll also receive treatment for the condition.
Behavior therapies
Behavior therapies may help you eliminate or lessen episodes of stress incontinence. The treatments your doctor recommends may include:
- Pelvic floor muscle exercises. Called Kegel exercises, these movements strengthen your pelvic floor muscles and urinary sphincter. Your doctor or a physical therapist can help you learn how to do them correctly. Just like any other exercise routine, how well Kegel exercises work for you depends on whether you perform them regularly.
A technique called biofeedback can be used along with Kegel exercises to make them more effective. Biofeedback involves the use of pressure sensors or electrical stimulation to reinforce the proper muscle contractions.
- Fluid consumption.Your doctor might recommend the amount and timing of fluids you consume during the day and evening. However, don’t limit what you drink so much that you become dehydrated.
Your Gynecologist may also suggest that you avoid caffeinated and alcoholic beverages because it’s believed that in some people these dietary irritants affect your bladder function. But, new research suggests that coffee and caffeine may not increase stress incontinence. If you find that using fluid schedules and avoiding dietary irritants significantly improves leakage, you’ll have to decide whether these changes are worth the improvement in leakage.
- Healthy lifestyle changes.Quitting smoking, losing excess weight or treating a chronic cough will lessen your risk of stress incontinence as well as improve your symptoms.
- Bladder training.Your doctor might recommend a schedule for toileting (bladder training) if you have mixed incontinence. More frequent voiding of the bladder may reduce the number or severity of urge incontinence episodes.
Medications
There are various approved medications to specifically treat stress incontinence.The antidepressant duloxetine (Cymbalta) is used for the treatment of stress incontinence.
Devices
Certain devices designed for women may help control stress incontinence, including:
- Vaginal pessary. A specialized urinary incontinence pessary, shaped like a ring with two bumps that sit on each side of the urethra, is fitted and put into place by your doctor or nurse. It helps support your bladder base to prevent urine leakage during activity, especially if your bladder has dropped (prolapsed).
This is a good choice if you wish to avoid surgery. A pessary will require routine removal and cleaning. Pessaries are used mostly in people who also have pelvic organ prolapse.
Surgeries
Laparoscopic bladder neck repair, Kelly’s repair, sling operations, burch colposuspensipn, TVT tape colposuspensipn are some of the surgical options.
Recently transvaginal RF LASER treatment is giving good results in stress and mixed incontinence.
Dr.Ruchi Tandon is a Gynecologist with 13 years experience in all cases of urinary leakage and urinary incontinence. She is practicing in leading hospitals in South Delhi.