What are the causes for Stress Urinary Incontinence?
Stress incontinence occurs when the tissue that supports your urethra gets weak.
The bladder and urethra are supported by the pelvic floor muscles. Urine flows from your bladder through your urethra to the outside.
The sphincter is a muscle around the opening of the bladder. It squeezes to prevent urine from leaking through the urethra.
When either set of muscles become weak, urine can pass when pressure is placed on your bladder. You may notice it when you:
Lift heavy objects
Weakened muscles may be caused by:
Injury to the urethra area
Surgery in the pelvic area or the prostate (in men)
Stress incontinence is common in women. Some things increase your risk, such as:
Pregnancy and vaginal delivery.
Pelvic prolapse. This is when your bladder, urethra, or rectum slide into the vagina. Delivering a baby can cause nerve or tissue damage in the pelvic area. This can lead to pelvic prolapse months or years after delivery.
What are the symptoms for Stress Urinary Incontinence?
The main symptom of stress incontinence is leaking urine when you:
Are physically active
Cough or sneeze
Stand from a sitting or lying down position
What are the current treatments for Stress Urinary Incontinence?
Treatment depends on how your symptoms affect your life.
There are 3 types of treatment for stress incontinence:
Behavior changes and bladder training
Pelvic floor muscle training
There are no medicines for treatment of stress incontinence. Some providers may prescribe a medicine called duloxetine. This medicine is not approved by FDA for the treatment of stress incontinence.
Making these changes may help:
Drink less fluid (if you drink more than normal amounts of fluid). Avoid drinking water before going to bed.
Avoid jumping or running.
Take fiber to avoid constipation, which can make urinary incontinence worse.
Quit smoking. This can reduce coughing and bladder irritation. Smoking also increases your risk for bladder cancer.
Avoid alcohol and caffeinated drinks such as coffee. They can make your bladder fill up quicker.
Lose excess weight.
Avoid foods and drinks that may irritate your bladder. These include spicy foods, carbonated drinks, and citrus.
If you have diabetes, keep your blood sugar under good control.
Bladder training may help you control your bladder. The person is asked to urinate at regular intervals. Slowly, the time interval is increased. This causes the bladder to stretch and hold more urine.
PELVIC FLOOR MUSCLE TRAINING
There are different ways to strengthen the muscles in your pelvic floor.
Biofeedback: This method can help you learn to identify and control your pelvic floor muscles.
Kegel exercises: These exercises can help keep the muscle around your urethra strong and working well. This may help keep you from leaking urine.
Vaginal cones: You place the cone into the vagina. Then you try to squeeze your pelvic floor muscles to hold the cone in place. You can wear the cone for up to 15 minutes at a time, two times a day. You may notice improvement in your symptoms in 4 to 6 weeks.
Pelvic floor physical therapy: Physical therapists specially trained in the area can fully evaluate the problem and help with exercises and therapies.
If other treatments do not work, your provider may suggest surgery. Surgery may help if you have bothersome stress incontinence. Most providers suggest surgery only after trying conservative treatments.
Anterior vaginal repair helps restore weak and sagging vaginal walls. This is used when the bladder bulges into the vagina (prolapse). Prolapse may be associated with stress urinary incontinence.
Artificial urinary sphincter: This is a device used to keep urine from leaking. It is used mainly in men. It is rarely used in women.
Bulking injections make the area around the urethra thicker. This helps control leakage. The procedure may need to be repeated after a few months or years.
Male sling is a mesh tape used to put pressure on the urethra. It is easier to do than placing an artificial urinary sphincter.
Retropubic suspensions lift the bladder and urethra. This is done less often due to the frequent use and success with urethral slings.
Female urethral sling is a mesh tape used to support the urethra.
What is the outlook (prognosis) for Stress Urinary Incontinence?
Getting better takes time, so try to be patient. Symptoms most often get better with nonsurgical treatments. However, they will not cure stress incontinence. Surgery can cure most people of stress incontinence.
Treatment does not work as well if you have:
Conditions that prevent healing or make surgery more difficult
Other genital or urinary problems
Past surgery that did not work
Poorly controlled diabetes
Previous radiation to the pelvis
What are the possible complications for Stress Urinary Incontinence?
Physical complications are rare and most often mild. They can include:
Irritation of the vagina lips (vulva)
Skin sores or pressure ulcers in people who have incontinence and can't get out of the bed or chair
Urinary tract infections
The condition may get in the way of social activities, careers, and relationships. It also may lead to:
Depression or anxiety
Loss of productivity at work
Loss of interest in sexual activity
Complications associated with surgery include:
Fistulas or abscesses
Bladder or intestine injury
Urinary incontinence -- if you have trouble urinating you may need to use a catheter. This is often temporary
Pain during intercourse
Wearing away of materials placed during surgery, such as a sling or artificial sphincter
When should I contact a medical professional for Stress Urinary Incontinence?
Call your provider if you have symptoms of stress incontinence and they bother you.
How do I prevent Stress Urinary Incontinence?
Doing Kegel exercises may help prevent symptoms. Women may want to do Kegels during and after pregnancy to help prevent incontinence.
American Urological Association website. Surgical treatment of female stress urinary incontinence (SUI): AUA/SUFU guideline (2017). www.auanet.org/guidelines/stress-urinary-incontinence-(sui)-guideline. Published 2017. Accessed February 13, 2020.
Hashim H, Abrams P. Evaluation and management of men with urinary incontinence. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 72.
Kobashi KC. Evaluation and management of women with urinary incontinence and pelvic prolapse. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 71.