Stress Incontinence

Stress incontinence happens when physical movement or activity such as

• coughing,
• sneezing,
• running
• or heavy weight lifting

will result in increased pressure on urinary bladder leading to urination.

Stress incontinence is not related to psychological stress. Stress incontinence can make a person feel embarrassed, isolated and limit working ability along with social life.

Signs and symptoms of stress incompetence include urine leakage while:

• coughing,
• sneezing,
• lauging,
• standing up,
• leaving a car,
• lifting something heavy,
• exercising and while having sex. 

Stress incompetence is caused when muscles of urinary bladder and sphincter weaken.

Pelvic floor muscles and urinary sphincter may lose strength because of:

• Childbirth - in women muscles of bladder weaken due to damage caused to the nerve during child birth.
• Prostate surgery - surgical removal of prostate gland due to pathological process of prostate gland.

Location of sphincter is right below the prostate gland prostatectomy may loosen the sphincter of prostate gland. Other factors which may worsen the situation are:

• illness that causes chronic coughing and sneezing,
• obesity,
• smoking,
• high impact
• and hormonal deficiency.

To make a diagnosis of stress incontinence, your doctor may recommend you to a urologist.

Bladder function tests may include:

Measurements of post-void residual urine

Concerns about emptying bladder completely can be cleared through this procedure. To measure the residual volume of urinary bladder after voiding a thin tube known as catheter is passed through urethra this tube can evacuate the remaining fluid which can be calculated to estimate residual volume.

Measuring bladder pressure

In some people who had neurological disease of spinal cord, will need cystometry.

During this method a catheter is inserted into urinary bladder and warm fluid is injected slowly. Tests of bladder leakage will be done during filling to check stress incontinence.

Creating images of bladder as it functions- video urodynamic uses imaging to create pictures of urinary bladder as it fills and during emptying.

Cystoscopy

This examination of the bladder and urethra using a scope inserted into the bladder.

Following treatment methods are recommended for stress incontinence:

• Vaginal pessary: This device supports the bladder and prevents urine leakage during activity.
• Urethral inserts: This device is inserted into the urethra and acts as a barrier to stop urination.

Surgery

The following surgical interventions are used:

• Injectable bulking agents: These material increase the mass around the urethra and improves closing ability of sphincter.
• Retro pubic colposuspension: It helps to lift and support tissues near the neck of bladder and upper portion of urethra.
• Sling procedure: Person’s own tissue, synthetic material or donor tissue is used to create a sling that supports urethra. This can also be used in men.
• Inflatable artificial sphincter: A cuff which fits around the upper portion of urethra acts as sphincter. This procedure is used primarily to treat men but can be used in women in rare cases. 

Following preventive measures should be taken for stress incontinence:

• maintaining weight according to age,
• eating high fiber foods,
• avoiding smoking and alcohol and avoid coffee.

The following alternative remedies are recommended by therapist to ease the symptoms of stress incompetence:

• Pelvic floor muscle exercises to strengthen pelvic floor muscles and urinary sphincter.
• Maintaining proper amount and timing of fluids consumed a day.
• Avoiding alcoholic beverages and caffeinated drinks to prevent irritation of bladder.
• Quitting smoking and Loosing excess weight. 

Lifestyle modifications are necessary in order to cope with stress incontinence.

Treatments often do not eliminate urine leakage but it does reduce the symptoms. It is a component of mixed incontinence and requires support.

• Being ready - taking along sufficient incontinence pads or protective undergarments and possibly a change of clothes may help to feel more comfortable when going out. Being familiar with restrooms of the destination will allow easy access. Changing the garments when they are wet helps to keep the skin dry and away from irritation.

• Sexuality and incontinence - talking with the partner, emptying the bladder before, and trying different positions may make leakage less likely.

• Support groups - talking to people with similar condition and joining support groups like National association for continence will provide resources and information about this disorder. 

There are several risks and complications associated with stress incontinence.

Factors that increase the risk of developing stress incontinence include:

• Age - although stress incontinence is not normal in the process of aging buy some conditions like weakening of muscles can lead to the development of stress incontinence.

• Type of childbirth delivery - multiple vaginal deliveries and delayed labor is associated with later development of stress incontinence.

• Body weight - people who are overweight have a higher risk of stress incontinence. Excessive weight increases pressure on abdomen resulting in weakening of muscles.

• Previous pelvic surgery - hysterectomy in women and prostatectomy in men can alter the strength of muscles.

Complications of stress incontinence include:

• personal distress,
• mixed urinary incontinence,
• skin rash or irritation part of the skin which is always in contact with urine develops in rash and irritation.