Stress Incontinence

The definition of urinary incontinence is the unintentional loss of urine related to another physical stress or underlying medical condition. For example, individuals who have benign prostatic hypertrophy can suffer from urinary incontinence which is related to the weakening of the bladder muscle and the constriction of the urethra.

Stress incontinence is another cause of urinary incontinence and is most common in women. The leakage of urine is usually prompted by a physical movement or activity that puts additional pressure or stress on the bladder. These types of movements or activities can include lifting something heavy, coughing, sneezing or laughing. Stress incontinence is not related to psychological stress and has its roots in changes in the physical structure of the individual.

Women who are experiencing stress incontinence will notice urine leaking when they cough, sneeze, laugh, stand up, lift something heavy or are exercising. Urine leakage may not happen every time you do one of these activities, but pressure increasing activity will only increase the risk of unintentional loss, especially when the bladder is full.

The urinary tract system consists of the kidneys, ureters (tube that leads from the kidney to the bladder), bladder and urethra (tube that leads from the bladder to the outside). During urination the muscles in the walls of the bladder contract to force the urine out of the body through the urethra. At the same time that this happens, the sphincter muscles around the urethra relax and allow the urine to come out of the body.

Urinary incontinence happens if the detrusor muscles are not strong enough to hold the urine back when the bladder contracts. This means that it takes much less pressure to expel urine from the body than it does if the muscles are not damaged.

Women who experience stress incontinence find that it results from one or two different things. These factors occur over many years and are not single events which may be addressed. For instance, events that can injure the support structures in the bladder such as the pelvic floor muscles, vagina and ligaments will affect the development of urinary incontinence. Childbirth and age are two events which have this effect on the body.

During pregnancy and childbirth the supporting structures of the bladder can be injured. This initial injury may not be significant enough to cause urinary incontinence immediately, but without muscle strengthening and rehabilitation it will degenerate over time. The second factor, aging, is impacted by the decreased level of estrogen in the body as a woman ages. This estrogen has a protective factor in keeping the musculature strong. When the estrogen decreases the muscles of the pelvic floor, bladder and urethral sphincter also weaken.

The first step that a woman should do is seek the advice of a physician who has experience in diagnosing and treating stress incontinence. Initially a woman may require the care of her urologist to determine the exact type of urinary incontinence. A urogynecologists is a physician who focuses on the urinary tract system and associated pelvic problems which women can experience.

A physician will use a full medical history and physical examination to begin the diagnostic process. Medical history will include your current pattern of voiding and any leakage that you are experiencing. The physician may also ask that you keep a bladder diary for several days to reveal obvious factors which can help define the problem. If these methods are unsuccessful in defining the type of incontinence a woman is experiencing the doctor may recommend other testing including ultrasound, cystoscopy, or urodynamic bladder stress test.

Women who experience stress incontinence often respond well to behavioral treatment recommendations which include bladder retraining and Kegel exercises. Bladder retraining means using the bathroom at regular time intervals to assist the individual to gain control. As you gain further control over leakage you can extend the time between scheduled trips to the bathroom.

Kegel exercises are designed to help strengthen the urethral sphincter and pelvic floor muscles. The first step is to identify the correct muscles so that you know what you are exercising. One way to find the correct muscles is to imagine that you\’re sitting on a marble and want to pick it up using the muscles of your vagina. Another way to identify the correct muscles is to attempt to stop the stream of urine as you are voiding.

It is important not to engage any other muscles at the same time such as your stomach, legs or buttocks because it can add more pressure to the bladder control muscles. Do not practice this while holding your breath and do not overdo it. When first starting Kegel exercises you should practice in a quiet room by yourself. Hold them exercise for a count of three and then release. Work up to doing three sets of 10.

Be patient with yourself and do not give up. By doing these exercises just five minutes a day you can improve your bladder control in a short as three weeks. When your muscles get stronger you can do these exercises while sitting or standing in when you are more experienced you can do them at the office, driving the car or even at the dinner table because no one will know.

Remember that urinary incontinence is a common problem in women and you should not be embarrassed. This type of incontinence is treatable at all ages and with treatment women find they are not as socially isolated and can leave a home without fear.

RESOURCES

US National Library of Medicine: Stress Incontinence

MayoClinic: Stress Incontinence

University of California San Francisco: Stress Incontinence in Women

New York University Langone Medical Center: https://www.aan.com/

National Kidney and Urologic Diseases Information Clearinghouse: Urinary Incontinence in Women