Stress urinary incontinence

Stress Urinary Incontinence in Women

Many women are affected by stress urinary incontinence. The condition affects millions of women. In fact, a study done in 2002 found that 32% of women in the UK had had symptoms of incontinence in the previous 30 days.

Another study done in America found that, on average, women waited 6.5 years after beginning to experience symptoms of incontinence before seeking help from their doctor. Many women are embarrassed to admit that they are incontinent and may assume that incontinence is to be expected as a result of having given birth, or as a natural by-product of aging. Incontinence is never normal and it is important that women of any age who experience incontinence seek medical care. Incontinence can be managed, and sometimes cured, with treatment options.

What is Stress Urinary Incontinence?

Stress urinary incontinence is the involuntary release of urine at inappropriate times. It occurs when stress is placed on the bladder, which causes intra-abdominal pressure to increase. Most women will find that activities like coughing, sneezing, lifting heavy objects, and exercising may cause them to become incontinent.

The underlying cause of this type of incontinence is weakness of the sphincter, or valve, that keeps the bladder outlet closed and prevents urine from leaking out. It may be caused by weakness of the pelvic floor muscles that can cause the urethra to move out of its normal position.

Childbirth is frequently associated with stress urinary incontinence. Childbirth may cause damage to pelvic floor muscles, the urethra, the bladder, or to nerves that supply these structures. Risk of incontinence increases if the birth is complicated, such as prolonged labor, use of forceps, large episiotomies, and delivery of very large-birth weight babies.

Diagnosis of Stress Urinary Incontinence

It is important for any woman who experiences incontinence to seek help from a medical professional, who can distinguish stress incontinence from other types of incontinence and determine the cause. Women should first consult their family doctor. The doctor may perform a general exam to rule out systemic illness as a cause of the incontinence. He or she will likely take a urine sample to test for infection, and ask a series of questions to learn more about the nature of the incontinence.

Questions that may be asked include:

• When did the incontinence start?
• How often is the patient incontinent?
• Is the incontinence worse during the night?
• Is the patient able to hold their urine when needed?
• Are there any other symptoms, such as pain or blood in the urine?
• Is the patient on any medications?
• Does the patient have frequent constipation?
• How does being incontinent affect the patient’s life?
• How has the patient been coping with the incontinence?

It may be helpful if the patient keeps a diary for a week prior to the doctor’s visit, detailing fluid intake, episodes of incontinence, and factors associated with the incontinence (i.e. sneezing, coughing). Answers to the questions asked by the physician will help to pinpoint the cause of the stress urinary incontinence, and may point to the need for further testing. The doctor may recommend that the patient see a urologist (a specialist in disorders of the urinary tract) or a gynecologist (a specialist in disorders of the reproductive system).

If further tests are needed, they might include:

• Ultrasound- to check for bladder stones, kidney disease, or other disorders of the urinary tract
• Voiding Cystourethrogram- to study urine flow and bladder capacity
• Cystoscopy- to examine the urethra and bladder from the inside, through a scope
• Post-Void Residual- to measure if any urine is left in the bladder after the patient voids

Treatment of Stress Urinary Incontinence

Treatment for this type of incontinence may involve treatments that a patient can employ at home, and may also consist of medications and surgery, if warranted.

Treatments that a patient may try at home consist of:

• Cutting down or eliminating caffeine intake
• Losing weight, if the patient is overweight
• Decreasing fluid intake, if the patient drinks fluids excessively
• Bladder training, in which the patient gradually increases the time between voids
• Kegel exercises, which help to tone the bladder and pelvic floor muscles

If self-help measures fail, there are several medications that a physician may prescribe to help the problem. These medications are aimed at relaxing the bladder and preventing bladder spasms. Yentreve is the first drug approved for treatment of women with moderate to severe stress urinary incontinence, and is only available in the UK.

Surgery may be needed in cases of severe incontinence not amenable to self-help remedies or medications. Surgery might be offered if the patient feels her symptoms are intolerable and her quality of life is severely impacted. Common surgeries to treat stress urinary incontinence consist of procedures to support the bladder and urethra and injection of bulking agents into the tissue surrounding the urethra to support the urethra and prevent the leakage of urine. Correcting any damage sustained from childbirth may help cure incontinence.

Incontinence is a condition that affects millions of women, yet many women do not seek help for their condition. Embarrassment over their condition may prevent women from discussing the problem with their physician. Curing the problem begins with a visit to the family doctor, who will order tests depending on the history and physical exam. The patient may be referred to a specialist. Tests may be performed in hospital on an outpatient basis to try and pinpoint the cause of the incontinence. Women can try one or more of several self-help remedies. Medications or surgery may be offered if simple measures do not help. Above all, women should know that they are not alone and that medical professionals can offer help and support for their stress urinary incontinence.

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