All That You Wanted To Know About Urinary Stress Incontinence
Urinary incontinence is a common problem that can cause a lot of embarrassment to a person. There are many types of urinary incontinence including stress incontinence, overflow incontinence, functional incontinence, urge incontinence and mixed incontinence.
Stress incontinence is the most common among them. It is more prevalent in women than in men. Surveys report that every 4 out of 100 people have stress incontinence. Every one out of three women gets this condition at some point in their life.
What is urinary incontinence and what is urinary stress incontinence?
Urinary incontinence is the inability to hold urine in the urinary bladder. It results in unintentional leakage of urine. Urinary stress incontinence is the involuntary leakage of urine due to physical activities that cause stress on the bladder. The physical activities that cause urinary stress incontinence include coughing, sneezing, laughing, exercising and heavy lifting.
What are the causes of urinary stress incontinence?
There is a short tube at the end of the urethra through which the urine flows while urinating. This tube remains closed in normal people. There are two muscles that help an individual to control urine. They are the sphincter muscles and detrusor muscles.
When these muscles are weakened, the tube at the end of the urethra is not able to remain closed when force is exerted on the bladder. This causes leakage of urine before the patient visits the toilet. Weakened pelvic muscles are also one of the causes for this problem.
The causes of stress incontinence in women include the following.
When a woman is pregnant, the extra weight of the baby puts extra stress on the pelvic muscles. This weakens the pelvic muscles and lead to involuntary leakage of urine.
2. Child birth
The chances of the pelvic floor getting bruised are more in case of vaginal delivery.
3. Hormonal changes a week before the onset of menstrual cycle and during menopause. Decrease of hormones lowers the muscular pressure around the urethral region. This results in urinary stress incontinence.
It is natural for muscles to get weakened due to aging. Pelvic muscles are likely to become weak which increases the risk of development of stress incontinence.
The main cause of stress incontinence in men is prostate surgery. Prostatectomy or the surgical removal of prostate lowers the urethral support and this causes an unintentional leakage of urine.
What are the risk factors for urinary stress incontinence?
1. Gender – Being female.
2. Obesity and overweight.
4. Excessive intake of alcohol.
5. Excessive consumption of caffeinated drinks.
6. Chronic cough.
7. Medications that increase the production of urine.
9. Sports activities.
10. Urinary tract infection.
Why should urinary stress incontinence be diagnosed and treated?
Urinary stress incontinence may cause a lot of personal distress. It affects the day to day activities, the social life, performance at work, personal relations between the sexual partner and may lead to mental depression.
More over the skin that is in constant contact with urine may become irritated and scarred. To avoid all these problems it should be diagnosed in the early stages and right treatment must be given as soon as possible.
How can urinary stress incontinence be diagnosed?
A thorough physical examination is done. Focus is given to genital exam in men and pelvic exam in women. Rectal exam is done for both the sexes. Urinary tests and blood tests are done to detect infections, presence of blood and other abnormalities if any.
Neurological exam may be recommended to rule out the possibility of neurological disorder.
Apart from the above some specialized tests may be ordered. They include
1. Urine stress test.
2. Pad test.
3. Pelvic ultrasound.
4. PVR to measure the residual urine left after urinating.
8. Cystometry to measure bladder pressure.
9. Urodynamic studies.
What are the treatment options for urinary stress incontinence?
Treatment options depend upon the causes and the severity of the symptoms.
Medications are prescribed to treat mild to moderate stress incontinence. The medications include anticholinergic drugs, antimuscarinic drugs, antidepressant and alpha-adrenergic drugs.
In severe cases surgeries may be needed to treat the condition. The surgical options include
1. Sling procedure in which a sling is created to support the urethra. This surgery is performed to treat the condition in women.
2. Artificial sphincter in which a valve is inserted to control the flow of urine from the bladder.
3. Colposuspension which involves the lifting of bladder neck.
4. Injecting collagen or gel to increase the pressure on the urethra.
5. Retropubic suspension.
6. Anterior vaginal repair.
Pelvic floor exercises or kegel
They are done to strengthen the pelvic muscles. These exercises are taught by the physical therapist or the health care provider. Following a regular routine is very effective in treating stress incontinence.
There are devices like vaginal pessary, vaginal cones, bio feedback devices and urethral inserts to treat stress incontinence.
Apart from the above treatment options some lifestyle modifications are essential to treat this problem. They include the following.
1. Regulating the fluid intake.
2. Avoiding physical activities that trigger leakage of urine.
3. Quitting smoking.
4. Reducing the intake of alcohol and caffeinated drinks.
5. Losing weight if overweight is the cause of stress incontinence.
6. Avoiding foods that increase the production of urine.
Urinary stress incontinence is treatable. It is better to seek immediate medical attention to avoid many complications.