Stress Incontinence – Symptoms, Diagnosis & Treatment

Stress Incontinence or Stress Urinary Incontinence is a condition when urine leaks out of when pressure is applied on the abdominal area due to sneezing, coughing, lifting weights etc. When the condition is severe, even very little pressure can make the urine leak out of the bladder. Urine leakage happens due to the weakening of the muscles and tissues around the bladder and urethra that control the pressure on them. Stress Incontinence is most often seen in women than in men.

How is urine released from bladder in normal conditions?

1. Urine from the kidneys gets collected in the bladder. The muscles around the bladder are usually relaxed.
2. Urethra is connected to the bladder till the end near the vagina. The muscles around the urethra (sphincter muscles) hold the urethra tight so that urine doesn’t leak out.
3. When the bladder is full, it sends a signal to the spinal cord and the brain which tells you that you need to use the restroom to relieve yourself.
4. When you start relieving yourself, the muscles around the bladder compress the bladder and the muscles around the urethra relax to allow the passage of urine.
5. The muscles get back to their previous condition once the bladder is emptied.

In case of those who are suffering from stress urinary incontinence, when little pressure is applied on the abdominal area (while laughing or coughing), the muscles around the urethra relax and a little amount of urine leaks out of the bladder.

Symptoms of Stress Incontinence

Urine leakage with cough, laugh, sneeze or lifting weights is the most common symptom of stress incontinence. Mild stress incontinence can leak only very little urine on application of high pressure such as that during workout. If the urine is leaking even on application of little pressure like even pressing on the abdomen or just by bending, then you are suffering from severe stress incontinence.

Stress urinary incontinence is a bothersome condition. Women with stress incontinence may use pads to protect their dress and they have to visit the restroom more frequently to keep the bladder empty. The quality of life is affected which may even affect the work or even personal life.

Causes of Stress Incontinence

Weakening of pelvic floor muscles is the cause of stress urinary incontinence. How and when these muscles become weak depend on various factors including:

1. Vaginal child birth. Multiple vaginal child births worsen the problem. A woman’s pelvic muscles are stretched and torn very badly during pregnancy and during child birth. The muscles try to heal and get back to their previous strength and firmness but the enormous pressure damages them very badly.
2. Accident or injury in the abdominal area can damage the pelvic floor muscles.
3. Surgery in the abdominal region (for any other medical condition) can hurt or damage the muscles in the abdominal area that can result in stress urinary incontinence.
4. Overweight and obesity, similar to pregnancy lays a lot of stress and pressure on the abdominal muscles which can make them eventually lose their strength.
5. Nerve injury to the lower back is also another reason why the pelvic floor muscles can become weak.

Diagnosis of stress urinary incontinence

Physical examination

When you report the problem to your gynecologist (even if you have a family physician, it is better to see an experienced gynecologist near you), he/she will start with a set of questions regarding your recent delivery, medical history and the medicines that you are taking. This will be followed by a physical examination of the pelvic region. Your doctor will try to assess the strength of pelvic floor muscles.

Pad Test

To assess the amount of urine that is being leaked, your doctor may give a one hour pad or a 24 hour pad to test. Once the duration is over, the pad is weighed to check the amount of urine leaked. The more you leak, the severe is the problem.

Bladder function test

1. Your doctor will test and see how much urine is left inside the bladder after you empty it. This is called ‘post-void residual urine test’. An ultrasound scan may be used to see the amount of urine left or a catheter may be used to drain out the remaining urine and measured.
2. Testing bladder pressure. Bladder will be filled with warm saline fluid and you will be asked to cough, laugh etc to check how well (or bad) your bladder is able to hold the fluids.

Cystoscopy – Your gynecologist inserts a thin tube with a camera at the end (Cystoscope) to look for any abnormalities inside the bladder and urethra.

Treatment of stress incontinence

If you are suffering from mild stress incontinence, your doctor may recommend some lifestyle changes including:

1. Working on pelvic floor muscles to strengthen them. (Kegel exercise is the most commonly advised workout).
2. Reduction in consumption of fluids. (You need to make sure you don’t dehydrate yourself).
3. Bladder training. Urinating at regular intervals helps in emptying it and not wait until it is full.
4. You may be advised to quit smoking, working on your weight if you are overweight or obese etc.

Devices to control urine leakage

1. Vaginal pessary (for incontinence) may be inserted into the vagina to support the bladder. This is usually used when the bladder drops (bladder prolapse) from it’s position.
2. Urethral inserts – These are most often used (inserted into the urethra) when you need to do strenuous jobs such as lifting weights or running etc to avoid urine leakage. They can be worn only until the end of such sessions or for a period of eight hours.

Surgical treatment for stress incontinence

Surgical treatment procedures for stress incontinence target giving some external support to the sphincter muscles or tightening the bladder neck (place where the urethra meets the bladder).

1. Sling procedure – A sling is made with tissue from other part of the body or an artificial material around the bladder neck and is sutured to the ligaments near the pubic bone. This acts as a support to the bladder neck reducing the symptoms of stress incontinence.
2. Injecting bulking agents – Gels or polysaccharides will be injected into the tissues around the urethra which help them put enough pressure on the urethra from opening.
3. Inflatable artificial sphincter – This surgical implant is used in men which acts like the sphincter muscles around the urethra.

Laser treatment for stress incontinence is the advanced treatment option that is available along with conventional methods. Learn more about laser treatment for stress incontinence.