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Stress Incontinence


It’s stressful: leakage with laughter, leakage with a cough, or leakage with exercise can put a damper on life. Stress incontinence is the leakage of urine that occurs when pressure is placed on the bladder.


Why is it leaky?

Normally, the urinary sphincter (or the valve-like muscles in the tube that carries urine out of the body) stays closed even as the bladder fills, allowing us to stay dry until we want to release.


Stress incontinence occurs when the urinary sphincter and the pelvic muscles that support the urethra weaken. Pressure from sudden forceful activities, such as sneezing or laughing, can overwhelm the weakened muscles ability to hold in urine, resulting in leakage.


The muscles and tissues of the pelvic floor can weaken due to:

  • Pregnancy and vaginal delivery

  • Injury to the urethral area

  • Surgery to the pelvic area, including prostate surgery in men

  • Some medications


Diagnosis

The diagnosis of stress incontinence can usually be made based on symptoms, thorough review of the medical history, surgical history, and current medications. The physical exam may include a rectal exam and a genital exam in men or a pelvic exam in women. A urine sample may be sent to rule out urinary tract infection. Some cases may require assessment of the bladder, urethra, and sphincter function.


Management

Specific exercises can help lessen or eliminate stress incontinence. These exercises include:

  • Bladder training. Regularly scheduled urination can keep the bladder empty for longer periods throughout the day.

  • Pelvic floor training. Kegel exercises (three sets of ten pelvic musculature contractions, held for ten seconds, three times a day) when performed frequently and routinely, can help strengthen the muscles of the pelvic floor.


There are also devices on the market to treat stress incontinence. These include:

  • Pessaries. In women with pelvic organ prolapse, a vaginal device may be inserted to help reposition and support the urethra.

  • Pelvic floor stimulation. This therapy delivers a small amount of electrical stimulation to the nerves and muscles of the pelvic floor and bladder to help them contract. These devices are worn externally, usually in underwear or a pair of shorts.


Surgery may be an option when conservative management with specific exercises and devices fail. Depending on the anatomy, surgical procedures to treat stress incontinence include:

  • Urethral sling. A small strip of material is placed under the urethra to prevent it from moving downward during activities.

  • Bladder neck suspension. The bladder neck and urethra are sutured in place to prevent them from moving and accidently opening.

  • Artificial urinary sphincter. A device is implanted in men to keep urine from leaking.


Regardless of the management approach, lifestyle modification should be part of the treatment plan. A healthy lifestyle to maintain include:

  • Maintenance of a healthy weight. People who are overweight or obese are more likely to develope stress incontinence. Losing weight reduces the severity and frequency of leaks.

  • Quit smoking. A chronic cough from smoking may increase the frequency and severity of leaks.

  • Maintenance of good bowel function. Constipation can make incontinence worse. Eat high fiber foods with at least 6 glasses of water each day to prevent constipation.




References

https://medlineplus.gov/ency/article/000891.htm

https://www.urologyhealth.org/urology-a-z/s/stress-urinary-incontinence-(sui)

https://www.nafc.org/female-stress-incontinence

Lugo T, Riggs J. Stress Incontinence. 2020 Nov 20. In: StatPearls

https://www.health.harvard.edu/bladder-and-bowel/stress-incontinence-overview