The inadvertent loss of pee is referred to as urinary incontinence. When physical movement or activity, such as coughing, laughing, sneezing, sprinting, or heavy lifting, exerts pressure (stress) on your bladder, causing you to leak urine, you have stress incontinence. Stress incontinence is unrelated to psychological stress.
Urgency incontinence and overactive bladder (OAB) are not the same as stress incontinence. Urgency incontinence, also known as OAB, occurs when your bladder muscle spasms, generating a sudden urge to urinate before you can get to the bathroom. Women are far more likely than men to experience stress incontinence.
You may feel ashamed, isolate yourself, or limit your work and social life if you have stress incontinence. You should also avoid strenuous and recreational activities. You should be able to manage your stress incontinence and enhance your overall well-being with treatment.
WHAT ARE THE SYMPTOMS OF STRESS INCONTINENCE?
If you have stress incontinence, you may leak pee when you do the following:
- Sneeze or cough
- Laugh
- Bend over
- Carry something hefty
- Exercise
- Have sex
It’s possible that you won’t leak pee every time you do one of these activities. However, any activity that increases pressure on your bladder can increase the likelihood of involuntary urine leakage, especially if your bladder is full.
WHAT ARE THE CAUSES OF STRESS INCONTINENCE?
When the muscles and other tissues that support the urethra (pelvic floor muscles) and the muscles that control urine release (urinary sphincter) weaken, stress incontinence develops.
As the bladder fills with urine, it expands. Normally, the valve-like muscles in the urethra — the short tube that transports pee out of your body — remain closed as the bladder swells, preventing urine leakage until you reach a restroom. When those muscles weaken, anything that puts effort on the abdominal and pelvic muscles — for example, sneezing, leaning over, lifting, or laughing hard — might put strain on your bladder and cause pee leakage.
Your pelvic floor muscles and urinary sphincter may weaken as a result of:
- Childbirth: Tissue or nerve injury during childbirth might impair the pelvic floor muscles or sphincter in women. Stress incontinence caused by this injury might occur immediately after birth or years afterwards.
- Prostate surgery: The most prevalent cause of stress incontinence in men is surgical removal of the prostate gland to treat prostate cancer (prostatectomy). This technique has the potential to weaken the sphincter, which is located just beneath the prostate gland and encircles the urethra.
Factors that contribute to stress incontinence development
Other things that may aggravate stress incontinence are:
- Infections that induce persistent coughing
- Obesity
- Cigarette smoking, which can result in frequent coughing
- Over many years, high-impact exercises such as running and jumping
WHAT ARE THE RISK FACTORS FOR STRESS INCONTINENCE?
The following factors enhance the likelihood of developing stress incontinence:
Age: Physical changes that occur as you age, such as muscular weakness, may increase your risk of developing stress incontinence. Stress incontinence, on the other hand, can occur at any age.
Childbirth delivery method: Women who have had vaginal deliveries are more prone to develop urine incontinence than women who have had cesarean deliveries. Women who have undergone a forceps delivery to have a healthy baby sooner may be at a higher risk of stress incontinence. Vacuum-assisted deliveries do not appear to increase the risk of stress incontinence in women.
Body weight: Overweight or obese people are more likely to experience stress incontinence. Excess weight puts strain on the stomach and pelvic organs.
Previous pelvic surgery: In women, hysterectomy, and in men, prostate cancer surgery, can weaken the muscles that support the bladder and urethra, increasing the risk of stress incontinence.
WHAT ARE THE COMPLICATIONS OF STRESS INCONTINENCE?
Stress incontinence complications may include:
Emotional distress: You may feel humiliated and upset if you encounter stress incontinence throughout your daily activities. It can interfere with your employment, social life, relationships, and even your sexual life. Some people are embarrassed by the fact that they require pads or incontinence clothing.
Mixed urinary incontinence: Mixed incontinence is widespread and refers to both stress and urgency incontinence — the unintended leak of urine caused by bladder muscle contractions (overactive bladder) that produce an urgent need to urinate.
Irritation or rash on the skin: Skin that is in regular contact with urine may become irritating or uncomfortable, and it may eventually break down. If you don’t take precautions, such as utilizing moisture barriers or incontinence pads, this can happen with severe incontinence.
HOW IS STRESS INCONTINENCE DIAGNOSED?
During your visit, your doctor will look for indicators that could point to a contributing issue. Your appointment will almost certainly include:
- Medical history
- Physical examination, which may involve a rectal and pelvic examination in women.
- Urine sample to be tested for infection, blood traces, or other abnormalities
- A brief neurological exam will be performed to rule out any pelvic nerve issues.
- Urinary stress test, in which the clinician counts the amount of pee lost as you cough or bear down.
Bladder function tests
Most cases of urine incontinence do not necessitate additional testing. In some circumstances, your provider may request tests to determine how well your bladder, urethra, and sphincter are working (urodynamic tests).
Bladder function testing may involve the following:
- Post-void residual urine measurements: If your provider is concerned about your capacity to completely empty your bladder, especially if you are older, have had past bladder surgery, or have diabetes, he or she may offer this test. This test can determine how well your bladder functions.
An ultrasound scan, which converts sound waves into images, is used by a professional to determine how much pee remains in your bladder after you urinate. In some circumstances, a tiny tube (catheter) is inserted into your bladder through your urethra. The catheter removes any residual pee, which is then measured.
- Bladder pressure measurements: Cystometry is a test that measures the pressure in your bladder and the surrounding area as it fills. If you have had a neurologic illness of the spinal cord, your clinician may offer this test to screen for stress incontinence.
A catheter is used to slowly fill your bladder with warm liquids. You may be asked to cough or bear down as your bladder fills to check for leaks. This procedure may be combined with a pressure-flow study, which determines how much pressure your bladder must exert to completely empty.
- Creating images of the bladder as it works: A video urodynamics test employs imaging to create images of your bladder as it fills and empties. A catheter slowly instills warm fluid mixed with a dye that shows up on X-rays into your bladder while images are taken. When your bladder is full, you urinate to empty it, and the imaging continues.
- Cystoscopy: This test involves inserting a scope into the bladder to examine for blockages or abnormalities in the bladder and urethra. This technique is often performed in the office.
Any test results should be discussed with your provider, and you should decide how they will affect your treatment strategy.
WHAT ARE THE TREATMENTS FOR STRESS INCONTINENCE?
To treat incontinence, your doctor may recommend a mix of treatments. If an underlying cause or contributing factor, such as a urinary tract infection, is discovered, you will be treated for the condition as well.
Behavioral treatments
Behavior therapy may help you eliminate or reduce stress incontinence episodes. Your doctor may recommend the following treatments:
- Pelvic floor muscle exercises: You can learn how to do Kegel exercises to strengthen your pelvic floor muscles and urinary sphincter from your provider or physical therapist. How well Kegel exercises work for you, like any other exercise plan, is determined by how frequently you execute them.
Biofeedback can be used in conjunction with Kegel exercises to increase their effectiveness. The use of pressure sensors or electrical stimulation to promote appropriate muscular contractions is referred to as biofeedback.
- Consumption of fluids: Your provider may advise you on how much and when to drink fluids during the day and evening. However, don’t drink so little that you become dehydrated.
Your doctor may also advise you to avoid caffeinated, carbonated, and alcoholic beverages, as these might irritate and impair bladder function in certain people. If you discover that following fluid regimens and avoiding particular beverages considerably reduces leakage, you must decide whether these dietary adjustments are worthwhile.
- Healthy lifestyle modifications: Quitting smoking, decreasing weight, or treating a chronic cough will reduce your chances of stress incontinence and improve your symptoms.
- Training for the bladder: If you have mixed incontinence, your provider may suggest a toileting routine. Urge incontinence episodes may be reduced if the bladder is emptied more frequently.
Medications
In the United States, there are no approved drugs to treat stress incontinence. However, in Europe, the antidepressant duloxetine (Cymbalta, Drizalma Sprinkle) is used to treat stress incontinence.
When the medicine is withdrawn, the symptoms immediately reappear. The most prevalent side effect that causes people to quit taking the drug is nausea.
Devices
Stress incontinence may be managed with the aid of female-specific devices, such as:
- Vaginal pessary: Your provider will fit and place a specialist urinary incontinence pessary, which is fashioned like a ring with two bumps on each side of the urethra. It supports the base of your bladder, preventing pee leakage during activity, especially if your bladder has decreased (prolapsed).
If you want to avoid surgery, this is a good option. A pessary will need to be removed and cleaned on a regular basis. Pessaries are usually used in persons who have pelvic organ prolapse.
- Urethral inserts: This little tampon-like disposable device that is put into the urethra serves as a barrier to prevent leaks. It is typically used to avoid incontinence during a certain activity, but it can be worn all day.
Urethral implants are designed to be worn for up to eight hours each day. Urethral implants are often used exclusively for strenuous activities such as frequent lifting, running, or tennis.
Surgery
Surgical procedures for stress incontinence are intended to promote sphincter closure or to support the bladder neck. Surgical alternatives include:
- Sling procedure: This is the most popular procedure for women suffering with stress urine incontinence. The surgeon creates a sling or hammock that supports the urethra using the patient’s own tissue, synthetic material (mesh), animal or donor tissue.
Men with mild stress incontinence can also benefit from slings. In some males, the approach may alleviate symptoms of stress incontinence.
- Injectable bulking agents: Injections of synthetic polysaccharides or gels into tissues around the upper section of the urethra are possible. These compounds thicken the region around the urethra, which improves the sphincter’s capacity to close.
- Retropubic colposuspension: Sutures linked to ligaments along the pubic bone are used to elevate and support tissues near the bladder neck and upper region of the urethra during this surgical procedure. This operation can be performed laparoscopically or through an abdominal incision.
- Inflatable artificial sphincter: This surgically implanted device treats men. The sphincter’s function is replaced by a cuff that fits around the top portion of the urethra. The cuff is linked to a pressure-regulating balloon in the pelvic region and a manually operated pump in the scrotum through tubes.
HOME REMEDIES FOR STRESS INCONTINENCE
Stress incontinence symptoms can be alleviated by adopting a healthy lifestyle. These are some examples:
- Get rid of excess weight: If you have a body mass index (BMI) of 25 or more, decreasing weight can help lessen the total pressure on your bladder and pelvic floor muscles. Moderate weight loss may alleviate stress incontinence significantly. Consult your doctor for weight loss advice.
- Increase your fiber intake: If you have urine incontinence due to persistent constipation, keeping bowel movements soft and regular minimizes the tension on your pelvic floor muscles. To treat and prevent constipation, eat high-fiber meals such as whole grains, legumes, fruits, and vegetables.
- Avoid meals and beverages that can cause bladder irritation: If you notice that eating chocolate or drinking coffee, tea (regular or decaf), or carbonated beverages causes you to urinate and leak more frequently, try removing that drink, especially on days when you don’t want to be troubled by leaking.
- Don’t smoke: Smoking can cause a severe persistent cough, exacerbating the symptoms of stress incontinence. Many occurrences of bladder cancer are also caused by smoking.
