Stress Urinary Incontinence – Causes, Symptoms, Diagnosis, And Treatment
What is stress urinary incontinence?
Stress urinary incontinence is a condition, in which your bladder leaks urine while doing physical activity or exertion. It may happen when you cough or sneeze, lift something heavy, change positions, or exercise.
What causes stress urinary incontinence?
The most common cause of urinary incontinence is weakening of pelvic floor muscles and urethral sphincter muscles. These muscles control our ability to hold urine. Urinary incontinence occurs when they get weak or do not work.
When these muscles become weak, urine can leak when pressure is placed on the bladder. You may notice this happen when you:
- Lift heavy objects
Weakened pelvic floor muscles and urethral sphincter muscles may be caused by:
- Injury to the urethra area
- Some medicines
- Surgery in the pelvic area or the prostate (in men)
Stress urinary incontinence is the most common type in women. The following things can increase the risk for stress urinary incontinence:
- Having had more than one pregnancy and vaginal delivery.
- Have pelvic prolapse. This is when your bladder, urethra, or rectum slide into the vagina. Delivering a baby can cause nerve or tissue damage in the pelvic area. This can lead to pelvic prolapse months or years after delivery.
What are the symptoms of stress urinary incontinence?
The main symptom of stress urinary incontinence is leaking urine when pressure is exerted on the bladder. Urine may leak while doing:
- Physical activity
- Sexual intercourse
How is stress urinary incontinence diagnosed?
Your doctor will perform a physical exam and review your symptoms. The exam will include:
- Rectal exam
- Genital exam in men
- Pelvic exam in women
Your doctor may perform the following tests for diagnosis:
- X-rays with contrast dye to look at your kidneys and bladder.
- Cystoscopy to look inside the bladder.
- Pad weight test: You exercise while wearing a sanitary pad. Then the pad is weighed to find out how much urine you lost.
- Voiding diary: You track and record your urinary habits, leakage, and fluid intake.
- Pelvic or abdominal ultrasound.
- Post-void residual (PVR) to measure the amount of urine left after you urinate.
- Urinalysis to check for urinary tract infection.
- Urinary stress test: You stand with a full bladder and then cough.
- Urodynamic studies to measure pressure and urine flow.
How is stress urinary incontinence treated?
Treatment of stress urinary incontinence depends on the symptoms and their effect on your life. Usually, treatment includes behavior changes, pelvic floor muscle training, medications, and surgery.
Making the following behavior changes may help:
- Drinking less fluids.
- Don’t delay or hold urine when you feel the urge. Urinate right away when you feel the urge. This may help reduce the amount of urine that leaks.
- Avoiding jumping or running.
- Taking fiber to avoid constipation can help urinary incontinence.
- Quitting smoking can reduce coughing and bladder irritation. Smoking also increases your risk for bladder cancer.
- Avoiding alcohol and caffeinated drinks such as coffee may also help. They can cause the urge to urinate.
- Losing excess weight.
- Avoiding foods and drinks, such as spicy foods, carbonated drinks, and citrus may help. These foods irritate your bladder.
- If you have diabetes, keep your blood sugar under good control.
Pelvic Floor Muscle Training
The following things will help strengthen the muscles in your pelvic floor:
- Biofeedback: This technique can help you learn to identify and control your pelvic floor muscles.
- Kegel Exercises: These exercises can help keep the muscle around your urethra strong and functioning well. This may help stop urine leakage.
- Vaginal Cones: Place the cone into the vagina and try to squeeze your pelvic floor muscles to hold the cone in place. You can wear the cone for up to 15 minutes at a time, two times a day. You may notice an improvement in your symptoms in 4 to 6 weeks.
- Pelvic Floor Physical Therapy: Physical therapists will evaluate the problem and help with exercises and therapies.
Your doctor may prescribe one or more of the following medications for mild to moderate incontinence.
- Anticholinergic medicines to help relax the muscles of the bladder. They may include oxybutynin (Oxytrol, Ditropan), tolterodine (Detrol), darifenacin (Enablex), trospium (Sanctura), and solifenacin (Vesicare).
- Antimuscarinic drugs to block bladder contractions.
- Beta-agonist, such as mirabegron (Mrybetriq) to enhances bladder relaxation.
- Estrogen therapy to help improve symptoms in women who have gone through menopause. It is applied as a cream or inserted into the vagina as a tablet or ring.
- Imipramine, an antidepressant, to help relax bladder muscles.
If the above treatments don’t work, your doctor may recommend surgery, which may help severe incontinence. Generally, surgery is recommended only after trying other treatments.
- Anterior vaginal repair helps restore weak and sagging vaginal walls. This is used when the bladder bulges into the vagina (prolapse).
- Artificial urinary sphincter. This device is used to keep urine from leaking. It is used mainly in men.
- Bulking injections are given to make the area around the urethra thicker. This helps control leakage. The procedure may need to be repeated after a few months or years.
- Male sling is a mesh tape used to put pressure on the urethra. This procedure is easier to do than placing an artificial urinary sphincter.
- Retropubic suspensions to help lift the bladder and urethra.
- Tension-free vaginal tape to support the bladder and urethra.
- Vaginal sling procedure uses a sling to support the urethra.
If you have trouble completely emptying your bladder, your doctor may recommend a catheter. This is a very small tube that is placed in the urethra to drain urine from the bladder.
This feature is for informational purposes only and is not intended to substitute the expert guidance of a doctor. We advise seeing a doctor if you have any health concerns.