Stress Urinary Incontinence

Stress urinary incontinence is caused by weakened pelvic floor muscles or a weakened urethral sphincter leading to urine leaks whenever there is sudden physical pressure applied to the abdomen or bladder.This type of urinary incontinence causes sudden spurts of leaked urine when someone coughs, laughs, or sneezes, or with straining and exertion. Unlike other types of urinary incontinence, this condition is more likely to affect young and middle-aged women. However, it is difficult to estimate the number of people with urinary incontinence due to underreporting. More than half of women affected by stress urinary incontinence fail to seek medical help because of social stigma.

Risk factors for stress urinary incontinence include:

• age
• estrogen deficiency
• gender
• obesity
• pelvic radiation
• pregnancy and childbirth
• surgery (e.g., surgical removal of uterus [hysterectomy] or prostate gland [prostatectomy])
• vaginal or uterine prolapse

Stress urinary incontinence does not commonly affect men but can occur following prostate surgery.

Stress urinary incontinence is caused by weakened pelvic floor muscles (muscles that support the pelvic organs such as bladder) or a weakened urethral sphincter (a thick muscle that control the flow of urine out of bladder). Normally these muscles stay closed and hold urine as the bladder expands. Urine is leaked when there is pressure on the abdomen and bladder, forcing urine through the weakened muscles.

Pregnancy and childbirth may damage and weaken the pelvic floor muscles which support the bladder. This can prevent the bladder opening from closing completely and allow urine to spurt out with physical activity. For the same reason, medical issues such as vaginal or uterine prolapse and hysterectomy can also lead to stress urinary incontinence. For post-menopausal women, low estrogen levels can also weaken the pelvic floor muscles and lead to stress incontinence.

Stress urinary incontinence rarely occurs in men. However rarely, prostate surgery or other pelvic injuries may damage the muscles or nerves controlling the urethral sphincter leading to incontinence.

The symptom of stress urinary incontinence is a sudden spurt of leaked urine when you strain, exert, or put pressure on the abdomen. It can include sneezing, laughing, lifting objects, and physical activity. Some people may have mixed incontinence with symptoms including other types of urinary incontinence. In this case, your doctor will treat the dominant symptom.

While the amount of urine leaked is small, many with incontinence feel embarrassed due the loss of urine and its odours. They may avoid physical or social activities that can trigger stress urinary incontinence which can ultimately affected the quality and enjoyment of their life.

If the condition is left untreated, it can lead to skin conditions or skin infection.

Your doctor will make diagnosis by reviewing your history of symptoms and by performing a pelvic examination. Your doctor may ask about the time, frequency, what triggers the symptoms, and how urgent you feel you need to go to the washroom when it happens. He or she may ask you questions to differentiate it from other types of urinary incontinence and confirm that it is stress urinary incontinence.

Your doctor may confirm the diagnosis by asking you to drink water for a full bladder and then have you cough or apply pressure to your lower abdomen to check for urine leakage.

Your doctor may start the treatment of your stress urinary incontinence with lifestyle modifications and pelvic floor muscle exercises. They may ask you to drink less water, caffeine, or alcohol to reduce the likelihood of having symptoms as these liquids will cause your body to produce more urine. Weight-loss may also be considered as it is a risk factor for urinary incontinence.

Pelvic floor muscle training or Kegel exercises is a special set of exercises your doctor may instruct you to perform that target and strengthen your pelvic muscles. These exercises are highly effective in treating stress urinary incontinence by improving muscle tone in the muscles supporting the bladder and the muscles holding back urine. The exercise consists of  8 to 12 muscle contractions (10 seconds for each contraction), 3 to 5 times per day. It may take 6 to8 weeks for results, but you should continue for at least 15 to 20 weeks.

Your doctor may elect to use other forms of physical therapy if Kegel exercises are ineffective. This may involve the use of weighed vaginal cones to strengthen the pelvic floor muscles or may involve bladder training which is achieved by urinating at fixed intervals. Alternatively, pessaries may be used to support the pelvic floor muscles and compress the urethra to create more resistance against urine leaks. These can come in a variety of shapes but must be fitted individually. Additionally, biofeedback therapy with a physical therapist or electrical stimulation therapy may help you better control your pelvic floor muscles.

If necessary, pads or other protective garments may be used to be used to absorb urine leaks. But only pads specifically designed for incontinence should be used as menstrual pads are not absorbent enough.

Other options for the treatment of stress urinary incontinence may be explored if Kegel exercises, physical therapy, and lifestyle changes are not enough. Your doctor may consider surgery if your symptoms do not improve or if they believe that it will be more effective for you than the other treatment options.

If you want to avoid a surgical procedure, or if you’re not eligible for surgery, you may benefit from medication therapies. Vaginal estrogen cream can be used for post-menopausal women as treatment if there are both symptoms of mixed urinary incontinence and symptoms of vaginal atrophy. However, currently there are no drugs approved by Health Canada for the treatment of stress urinary incontinence alone.

Helpful tips for managing incontinence:

• Reduce caffeine and alcohol consumption as these cause your body to produce more urine.
• Reduce fluid intake to appropriate levels to help reduce your symptoms.
• In general, up to 8 cups of fluid per day is recommended. If you have constipation, you may need at least 8 cups of fluid per day.
• Weight loss can help reduce symptoms by lowering the pressure on bladder.
• Don't be embarrassed to discuss the issue with your doctor – many people experience symptoms of stress urinary incontinence.
• Check with your doctor before using absorbent pads as it can delay appropriate treatment.

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