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What is stress urinary incontinence?
Stress urinary incontinence is one type of uncontrollable leaking of urine.
Stress refers to a physical force, such as a cough or sneeze rather than emotional stress.
Women who have mild symptoms of stress incontinence may sometimes have a small spurt of
urine loss with a strong force like a bad cough or many sneezes. When stress incontinence
becomes more severe, leakage occurs more frequently and more easily, even with minor
exertion.
Mild stress incontinence is very common and if symptoms occur infrequently enough not
to be bothersome, treatment may not be necessary. However, when leakage becomes a social
or hygienic problem, or if a woman limits her activities to avoid leakage, then treatment
can help.
What causes stress urinary incontinence?
Many factors may work together to cause stress urinary incontinence. Normally,
the pelvic muscles and connective tissue (ligaments) help to support the urinary bladder
and urethra (the tube that empties the bladder). Stress incontinence occurs when abdominal
pressure forces urine past the urethra. This force may happen because there is a weakness
of the urethra, because the urethra has lost some support, or both. Weakness of the
urethra may be due to nerve or muscle damage. Loss of pelvic support commonly occurs at
the time of vaginal childbirth. Other factors are important too, because some women have
stress incontinence even if they have not had a baby or if they had a cesarean delivery.
Some factors that increase pressure on the bladder and urethra can cause or aggravate
stress incontinence. These factors include chronic lung conditions that cause frequent
coughing, bowel problems such as constipation and excessive straining during bowel
movements, and obesity.
Who is affected by stress urinary incontinence?
Many women first experience stress urinary incontinence during pregnancy,
although symptoms usually resolve after delivery. For some women, stress incontinence may
occur later in life, after menopause.
What are the symptoms of stress urinary incontinence?
The typical symptom of stress urinary incontinence is the sudden loss of a
spurt of urine with or immediately after a physical force like coughing, sneezing, or
jumping. Urinary frequency is not necessarily affected. Uncomplicated stress incontinence
is not usually associated with symptoms of urgency (not being able to hold urine and
feeling as if leakage may occur on the way to the bathroom). If there is a large amount of
urine loss as if the bladder is emptying completely, or if the leakage is delayed after a
physical force, then a different type of urinary incontinence may be the cause. It is also
possible to have a combination of types of incontinence. (Physicians call this mixed
incontinence.)
How do you find out if you have stress urinary incontinence?
If you have any of the symptoms mentioned above, see your physician. In
addition to a physical examination and urine testing for infection, you may need to
undergo testing of bladder function called urodynamics. This test involves making pressure
measurements of the bladder and urethra while the bladder is being filled with fluid using
a thin catheter.
What is the treatment for stress urinary incontinence?
There are many treatment options available for stress urinary incontinence. The
choice of treatment depends partly on the severity of symptoms. Usually, simpler
treatments are tried first and more advanced treatment, such as surgery, is reserved for
symptoms that have not improved or resolved.
Exercise
Pelvic muscle exercises are often effective, especially for mild symptoms of
stress incontinence. Like all exercise programs, the most benefit is obtained when the
exercises are done consistently.
Medication
Medication is sometimes used to treat stress incontinence. For example, some
antihistamines increase muscle tone around the urethra and are effective for some women
with stress incontinence.
Devices
There are several relatively new devices that are either worn in the vagina, to
support the bladder and urethra, or over the urethra to block urine leakage. These devices
may be especially useful for women who have occasional urine loss with specific
activities, and so need protection only part of the time.
Surgery
If simpler measures are not effective or if stress incontinence is severe, surgery
may be recommended. The goal of surgery is to support or suspend the bladder and urethra,
and so prevent urine leakage. There are many different procedures, including ones that can
be performed with minimally invasive techniques using laparoscopy.
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