Stress Incontinence

Urinary stress incontinence occurs when an activity such as coughing, sneezing, or exercising causes a small amount of urine to leak from the urethra, which is the tube urine passes through. Stress incontinence (SI) is the most common type of incontinence suffered by women and it can affect women of all ages. Older women are particularly vulnerable. In addition, women who have given birth are more likely to have stress incontinence.

What Causes Stress Incontinence?

With stress incontinence, movements and activities such as coughing, sneezing, and lifting put greater abdominal pressure on the bladder. That causes the leakage of urine.

A number of things can contribute to stress incontinence. For instance, it can result from weak muscles in the pelvic floor or a weak sphincter muscle at the neck of the bladder. A problem with the way the sphincter muscle opens and closes can also result in stress incontinence. Chronic coughing, smoking, and obesity may also lead to SI.

Stress incontinence, especially in women, is often caused by physical changes to the body. Things that can cause these changes include:

• Pregnancy and childbirth
• Menstruation
• Menopause
• Pelvic surgery
• Problems with muscles in the bladder -- the organ that holds urine -- and the urethra
• Weakened muscles around the bladder

In cases of stress incontinence, the muscles in the pelvis can weaken. This can cause the bladder to drop down into a position that prevents the urethra from closing completely. The result is a leakage of urine.

What Are the Symptoms of Stress Incontinence?

The main symptom of stress incontinence is a leakage of urine at times of physical movement or activity. Examples of the kinds of activities associated with urine leaking include laughing, coughing, lifting, or exercise. The leakage may be as little as a drop or two, or may be a "squirt," or even a stream of urine.

How Is Stress Incontinence Treated?

Self-help techniques and aids can be used to treat mild stress incontinence. In addition, there are a number of treatments available for stress incontinence:

Kegel exercises: Kegel exercises, also called pelvic floor exercises, help strengthen the muscles that support the bladder, uterus, and bowels. By strengthening these muscles, you can reduce or prevent leakage problems.

To do Kegel exercises, pretend you are trying to stop the flow of urine or trying not to pass gas. When you do this, you are contracting the muscles of the pelvic floor. While doing these exercises, try not to move your leg, buttock, or abdominal muscles. In fact, no one should be able to tell that you are doing Kegel exercises.

Kegel exercises should be done every day, five sets a day. Each time you contract the muscles of the pelvic floor, hold for a slow count of five and then relax. Repeat this 10 times for one set of Kegels.

Weight loss: Stress incontinence has been linked to obesity.

Timed voiding: Record the times that you urinate and when you leak urine. This will give you an idea of your leakage "patterns" so that you can avoid leaking in the future by scheduling bathroom visits at those times.

Device: The doctor can insert a device called a pessary into the vagina to stop stress incontinence. A pessary is a ring that, when inserted, puts pressure on the urethra in order to keep it in its normal location. Doing so can reduce urine leakage during exercise, sneezing, coughing, etc.. Possible side effects from using a pessary include vaginal discharge and infections. It may also worsen leakage is the bladder droppage is severe. Similarly, small weights can be inserted into the vagina and your pelvic muscles contract to hold them in while you are standing. They should be used about 15 minutes a day, twice a day. Also, pants with electrical padscan be worn to stimulate the muscles of the pelvic floor, strengthening and re-educating the muscles that help control bladder leakage.

Injections: Bulking agents are substances that are injected into the lining of the urethra. They increase the size of the urethra lining. Increasing the size creates resistance against the flow of urine. Collagen is one bulking agent that is commonly used. If successful, periodic injections may be needed.

Surgery: When other methods for treating stress incontinence don't work, surgery may be an option. Surgery is now minimally invasive and performed on an outpatient basis in most cases. There are three types of surgery designed to help keep the bladder in place and treat stress incontinence:

• Retropubic suspension: In this procedure, the surgeon makes an incision in the abdomen. The surgeon then attaches the neck of the bladder to the pubic bone with sutures.
• Sling procedure: In this procedure, the surgeon uses a sling made of either natural (cadaveric) tissue, your own fascia, or synthetic material. The sling goes around the urethra or bladder neck and is attached to the pubic bone.
• Artificial sphincters: Most frequently used for men but also may be appropriate for women. A fluid-filled cuff is implanted around the urethra that can be opened and closed by the patient and that serves as a valve to contain the bladder content that might otherwise leak.

These surgeries can effectively treat the vast majority of stress incontinence cases. Side effects of surgery include continued or worsened incontinence or an inability to urinate. Side effects of surgery include but are not limited to continued stress incontinence, worsening or new onset urge incontinence, mesh extrusion or erosion, infection, bleeding, urinary retention, pelvic pain, painful sex and/or damage to surrounding structures.

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