Stress incontinence is losing urine without meaning to during physical activity, such as coughing, sneezing, laughing, or exercise.
Stress incontinence occurs because of poor function in the muscles that support the bladder or control the release of urine. Sometimes both muscle groups are involved. The bladder expands as it fills with urine, but valve-like muscles at each end of the urethra — the short tube through which urine flows to exit your body — normally stay closed, or contracted, preventing urine release until you reach a bathroom. When the muscles supporting the bladder are weak, however, pressure can trigger urine release before you’re ready. Problems with the valves themselves (the urinary sphincters) may have the same effect. Your bladder may not even feel unusually full when you have urine leakage due to stress incontinence. Anything that exerts force on the abdominal muscles — sneezing, bending over, lifting, laughing hard — also puts pressure on your bladder. Your urinary sphincter and pelvic floor muscles may lose tone because of:
Other factors that may worsen stress incontinence include:
The main symptom of stress incontinence is losing urine without your control. It may occur when you:
The health care provider will perform a physical exam, including a:
In some women, a pelvic examination may show that the bladder or urethra is bulging into the vagina. Tests may include:
Treatment depends on how severe your symptoms are and how much they affect your everyday life. There are different types of treatment for stress incontinence:
Examples of behavior changes include:
Pelvic muscle training exercises (called Kegel exercises) may help control urine leakage. These exercises keep the urethral sphincter strong and working properly. Some women may use a device called a vaginal cone with pelvic exercises.
Medicines tend to work better in patients with mild to moderate stress incontinence. There are several types of medications that may be used alone or in combination. They include:
However, it is not clear whether estrogen treatment improves stress incontinence. Some hormone treatments given after menopause have been shown more harmful than helpful to women’s health. Women who have a history of breast or uterine cancer usually should NOT use estrogen therapy to treat stress urinary incontinence.
Incontinence products such as absorbent pads can be enormously helpful. They can prevent leaking onto your clothes, control odor, and prevent skin irritation. The best choice depends on your symptoms. If you’re just having occasional leaking or dribble, a drip collector, an absorbent padded sheath that goes around the penis — might do the trick. For mild cases, an incontinence pad inserted into the underwear and held in place with an adhesive strip might work. If you’re having more severe incontinence, a larger guard or pair of absorbent underwear may be what you need. External catheters – Unlike the catheters used at the hospital, external catheters for male incontinence are silicone or latex devices that go over the penis instead of into the urethra. They’re usually rolled on like condoms. The urine is sent through a tube into a drainage bag. Some men only use these devices at night. To prevent leaks, it’s very important to get the right fit and to follow the instructions from the manufacturer.
There is a new type of surgical treatment called transobturator tape for stress incontincne, which is used to create a hammock in the same way as an older treatment called tension free trans vaginal tape (TVT). The new procedure is known medically as TVT-O. Both treatments support the urethra and help it to close more tightly when the abdominal pressure is raised during coughing or exercising. The tape stays in place permanently. The procedure takes place under a general or spinal anaesthetic. A small incision (about 2 cm) is made in the vagina just below the opening of the urethra. A polypropylene tape (similar to the material used for surgical sutures) is passed outwards through small (0.5 cm) incisions made in the inner thigh. The tape is positioned without tension under the urethra and acts as a ‘backboard’ to support the urethral continence mechanism (sphincter) when coughing. The incisions are the closed with dissolvable stitches which disappear within 2-3 weeks of surgery. The TVT-O procedure takes about 30 minutes.
Traditional Tension Free Vaginal Tape (TVT) is designed for the same purpose as Transobturator tape, but is fitted in a different way. During both operations the surgeon places the tape under the middle part of your urethra. If the surgeon uses the traditional TVT method, the tape ends are passed behind your pubic bone and out through 0.5cm cuts in your abdomen, just above your pubic area. In the TVT-O the tape ends are passed sideways through a natural space in your pelvic bone through small incisions in your inner thigh. This means the surgeon does not go near to the bladder, reducing the risk of damage to the bladder, bowel or blood vessels. There is no need to cut your abdomen. The traditional TVT tape is passed around the urethra and can cause urethral compression, resulting in voiding difficulty or retention of urine. Since the TVT-O tape is passed laterally below the urethra, the tape is less compressive and the rate of voiding difficulty is significantly lower. The TVT-O tape is placed away from the bladder and causes less bladder irritation and secondary urge (overactive) symptoms, which occur in 10–15% of women after TVT tape placement.
Surgery is only recommended after the exact cause of urinary incontinence has been found. Most of the time, your health care provider will try bladder retraining or Kegel exercises before considering surgery.
Most health care providers recommend that their patients try other treatments before having surgery. Depending on the success of treatment and other medical problems you have, you may need a urinary catheter to drain urine from the bladder.
Dr Mahendra Jain is an eminent and an extremely experienced Urologist ...Read More
I had undergone treatment for my prostate in Germany 5 years back. Now I developed urethral stricture, I had lot of problem passing urine.
Mr Alexis is aged 72 yrs from East Africa was treated for his long standing urinary problem with a complex surgery. Now he is back in his country