What You Need To Know About Stress Incontinence

Urinary incontinence is a widespread issue – more prevalent in women than men.

In fact, out of the 25 million adults in the U.S. who are struggling with urinary incontinence, 75% to 80% are women. That means the condition is present in 4% to 35%  of the adult female population, strictly in the United States.

If you want to know more about stress incontinence, in general, and the impact it can have on your bladder, you’ve come to the right place. We prepared a detailed guideline of what happens to the human body when there is uncontrolled bladder leakage.  

What Is Stress Incontinence Exactly?

Stress incontinence is an accidental loss of urine. It can happen due to an activity or physical movement. For example, lifting a heavy object, jumping, running, sneezing, laughing, or coughing. Regardless of the type of abdominal pressure that’s affecting the bladder, the body will leak urine. 

To understand the incontinence, you need to be familiar with basic bladder anatomy. There is a system of muscles that support the bladder. You have the:

  • Pelvic floor muscles – responsible for supporting the urethra and bladder.

  • Detrusor contraction – a muscle located on the bladder wall that helps the bladder expand.

  • Sphincter – a muscle that encircles our urethra (the tube in charge of carrying the urine until it leaves the system).

Each of these muscles has a vital role to play in incontinence. For the bladder to hold the urine and not let it leak, the sphincter must be capable of contracting. However, when the pelvic floor is too weak, it becomes too hard to hold these muscles in place. 

That’s why the detrusor can’t work properly, and the urine starts to leak. Also, there are multiple incontinence types, such as functional incontinence, urge incontinence, mixed, and overflow incontinence. Stress urinary incontinence is just one of them. 

Note: Stress incontinence has nothing to do with actual emotional stress. And it’s completely unrelated to OAB (overactive bladder) or urgency incontinence. It is a different condition with its own set of causes, symptoms, and contributing factors. 

What Are the Signs of Stress Incontinence?

Stress incontinence is easy to spot. The typical symptoms appear when the bladder loses its control, and the patient experiences a couple of drops of urine leaks. 

This is what experts call urethral hypermobility. It means an unstable urethra and weak pelvic floor that’s unable to hold the urine. 

It can occur as a result of:

  • Sneezing

  • Coughing

  • Laughing

  • Heavy lifting

  • Physical activity

  • Sex

In some cases, a patient can experience incontinence whenever they try to stand up or recline from staying seated for too long. Since the change in posture can stress the bladder muscle, the patient can have involuntary urine leakage

Of course, incontinence is different for everyone. Some people may not experience these symptoms each time they do an activity. Instead, they can have urinary leakage from time to time. It all depends on how severe the problem is. So, it varies from one patient to the other. 

What Are the Typical Causes of Stress Incontinence

This type of urinary incontinence happens the moment the tissues and muscles responsible for supporting the urethra become too weak to hold the urinary sphincter. That’s why they end up releasing urine. 

Anything from sneezing to coughing will add force to the pelvic floor and abdominal muscles. With this kind of pressure, the bladder becomes incapable of holding in the urine. The urinary and pelvic floor muscles lose their strength often because of prostate surgery or childbirth. 

Prostate Surgery

In male patients, prostate surgery, which is basically a removal of their prostate gland, can often lead to this kind of incontinence. Since the surgery weakens the muscles, it can significantly impact how the bladder holds the urine. 

Studies show that urinary leakage is a typical side effect after a prostatectomy. The incidence rate can range from 1% to 40%. But, the overall prevalence rate tends to increase with each surgery. 

Like it is the case with intrinsic sphincter deficiency. This is a condition where the urethral sphincter can’t create a sufficient amount of (resting urethral) closing pressure. It can happen as a result of a surgery, for example, a failed bladder suspension procedure. In other words, the more surgeries you have, the bigger the risk of developing stress incontinence. 

Childbirth

After giving birth, women can experience numerous incontinence issues. The whole procedure will weaken the pelvic floor and result in an overactive bladder. So, it’s normal to experience some bladder control problems. 

During childbirth, women can damage their nerves – most of which are connected to the bladder. That’s because both the bladder and urethra move during pregnancy. This kind of displacement is known as intraabdominal pressure. 

When the pelvic floor is cut, as with episiotomy, the muscles weaken. Although it helps to deliver the baby, it can cause poor bladder control. 

Urinary problems caused by detrusor overactivity are often the most difficult to deal with. The neurological lesions can take a massive toll on the urethra and bladder function, which will reduce a person’s quality of life. 

Are There Any Contributing factors?

Yes, some factors could make incontinence worse. That includes:

  • Obesity – Experts believe the excess body weight adds additional pressure to the abdomen. That creates extreme urethral mobility and bladder pressure, which can result in stress urinary incontinence. For example, with overflow incontinence, an enlarged prostate can cause blockages. The bladder becomes too full and overflows. And obesity can cause prostate growth

  • Constant smoking – Smokers are vulnerable to urge incontinence. The longer they smoke, the bigger the risk of developing chronic coughing. This kind of health issue can cause significant stress to the pelvic muscle, making it weak. Not only can smoking cause incontinence, but it can also lead to numerous urologic diseases. 

  • Difficult exercises – The heavy load puts a strain on the pelvic muscles. Over time, it can make the bladder neck weaker and cause urge incontinence. 

What About Risk Factors?

Several risk factors can increase the likelihood of developing stress urinary incontinence. That includes:

  • Age

  • Bodyweight

  • Pelvic surgery

  • Childbirth

Age

Age plays a predominant role in urinary incontinence. The muscles get weaker, and the incontinence can happen at any time.

Older women have a higher risk of experiencing daily incontinence. Around 70% of women over the age of 60 experience this kind of problem. While only 45% of women younger than 60 struggle with this daily issue. 

The prevalence rate of daily urinary incontinence in older women is 14% to 35%. In younger women, the incontinence rate is less than 28%. 

Bodyweight

The likelihood of experiencing urge incontinence in the next 5 to 10 years increases from 30% to 60% for each 5-unit increase in your body mass index. While losing weight (with either surgery or healthy diets) can help keep the condition under control. 

That’s why people need to maintain a healthy body weight if they want to reduce their risk of developing urinary incontinence. 

Pelvic Surgery

Pelvic floor disorders are a common problem. They affect 25% of the female population in the U.S. In many cases, patients need to get surgery. Unfortunately, the surgery can weaken the bladder muscles and cause urinary problems. They will then need another surgery to get the condition under control.

In fact, around 20% of female patients will have surgery for pelvic organ prolapse and stress incontinence sometime in their life. With old age, the risk only increases. 

Childbirth

Patients who had vaginal delivery have a bigger risk of experiencing stress urinary incontinence than those who’ve had a cesarean section. That also includes female patients who have had a forceps delivery. 

How to Diagnose the Condition?

Consult with a doctor if you think you have urinary incontinence. Your doctor will then ask about your medical history and the symptoms you are experiencing. The rest of the appointment will probably feature a:

  • Physical exam (pelvic exam in females, rectal exam in males)

  • Urinary stress test (analyzing the amount of urine leakage based on a certain activity) Neurological exam (finding any nerve damage to the pelvic floor muscle)

  • Urine sample (pinpointing any bacteria, urinary tract infection, or various abnormalities)

If you are experiencing the typical incontinence symptoms, you won’t need any additional testing. But, if the doctor needs further analysis, particularly on how the urethra, sphincter muscles, and bladder are doing, they will suggest a bladder function test or urodynamic testing.

The doctor will measure the post-void residual urine, bladder pressure, urine release, urethra store, and more. If it’s necessary, they will suggest an X-ray. When the urinary tract is working properly, it means the natural drainage system can effectively remove the waste and extra fluid.

But, when there are blockages or abnormalities that affect urinary tract drainage, the doctor will suggest a cystoscopy. They will insert a scope inside the bladder and find these blockages. For the urinary tract to function normally, all the body parts must work together. That includes the bladder, urethra, and kidneys. 

Treatments

There are multiple strategies that can treat this urinary problem. Depending on the type of issue you are dealing with and the severity of the urinary incontinence, the doctor will suggest a mix of treatments or surgery. Here are the typical treatment options for managing this health disorder. 

Medication

Scientists haven’t created drugs that specifically treat incontinence. However, some medicines are a viable option for controlling this condition. Products like Drizalma Sprinkle and Cymbalta are the go-to choice. 

With this antidepressant duloxetine, doctors in Europe tend to treat the condition. Unfortunately, the symptoms will return after the patient has stopped taking the drug. In some cases, patients can also experience unwanted side effects after stopping their medication. 

Behavioral Therapy

Behavioral therapy can reduce and eliminate urinary incontinence episodes. Patients can do pelvic floor exercises, like Kegel exercises. They can also work on their bladder contraction with the help of electrical stimulation. 

Another option is bladder training. The doctor will suggest you stick to a toileting schedule, which can help reduce the urge and control the episodes. Controlled fluid consumption and healthy eating also have a major role to play.

With this type of therapy, patients get to watch their food and beverage intake to manage their need to urinate. The schedule can help them beat the urgency and soothe the symptoms. 

Incontinence Control Devices

Some products manufactured for female patients can help manage incontinence. These include:

  • Urethral inserts

  • Vaginal pessary

Urethral inserts are disposable devices, quite similar to a tampon. They form a solid barrier and can be worn for 8 hours. This gives women the opportunity to finish their daily activities and enjoy their free time. 

While a vaginal pessary is a ring-shaped device that sits on every side of your urethra, only a nurse or a doctor can secure it in place. The vaginal pessary adds an extra layer of support for the bladder, especially with a prolapsed bladder or pelvic prolapse.

Pessaries are a practical option for avoiding surgery and are mainly used on patients with pelvic organ pain and discomfort. But, they do need regular cleaning. 

Surgery

Doctors will suggest surgical treatment if a patient wants to fix the bladder neck support and sphincter closure. They can offer multiple solutions based on the patient’s health problem. Take a look at the list below to learn more about the typical surgery methods for urinary incontinence

These include:

  • Inflatable artificial sphincter – This is a typical procedure for men. The doctor will implant a cuff in the upper section of the urethra. This artificial urinary sphincter will replace the purpose of the sphincter and provide adequate urinary control. 

  • Retropubic colposuspension – With the help of sutures, the tissues and muscles will get all the support they need to control the bladder leak. 

  • Injections – Doctors will rely on bulking agents (synthetic gels or polysaccharides) to help the sphincter close. 

  • Sling procedure – The mid-urethral sling is a popular method used in female patients. The surgery involves using the patient’s tissue, mesh, or donor tissue, to form a hammock powerful enough to support the urethra and bladder neck. 

What Happens If I Leave Stress Incontinence Untreated?

Patients who don’t treat their condition can experience some complications. Such as: 

  •  Skin irritation – When there is always urine on the skin, the area can get inflamed, irritated, and sore. This could lead to an uncomfortable skin rash. To avoid such a problem, use incontinence pads or a proper moisture barrier to keep the involuntary leakage away from the skin. 

  • Mixed incontinence – When patients have both urgency incontinence and stress incontinence, it means they are struggling with mixed incontinence. Because of their bladder leak, they have an urgent need to urinate.  

  • Emotional struggles – Incontinence can take a toll on your psychological health. It will interfere with your activities and can make you feel stressed and embarrassed. Therefore, it is essential to try and treat the problem so that you can overcome these emotional boundaries. 

Life After Treatment

The purpose of any treatment for this particular urinary problem is to boost your quality of life. When you pair surgery with lifestyle changes or therapy, you can get your pelvic floor back on track. With adequate care, you can reap numerous benefits of these treatment opportunities. 

It’s crucial that you get enough rest for a couple of weeks. This will help the body recover and heal properly. Plus, exercise can maintain pelvic floor muscle strength. This will allow you to be in complete control of your urinary issue. 

If you had surgery, the doctor would ask for follow-up care. You would need to visit the surgeon between 6 weeks and six months. They will guide you through the whole recovery process. 

Conclusion 

Stress incontinence is not a simple urinary problem. There are numerous causes, risk factors, and complications that can happen because of it. It can be an embarrassing condition to deal with. But, there is nothing to be embarrassed about. This treatable condition can happen to anyone, both men and women. 

Just talk to a doctor and let them know about your condition. Explain the symptoms you might be experiencing and the way they affect your life. The doctor will suggest the ideal treatment that will work with your particular health issue. 

Now that you know all the diagnostics and treatment options, you will be in complete control of your urinary dysfunction.

Next Up

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Learn How To Regain Control Of Your Bladder.

Sources

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Alternative Text

Dr. Ahmed Zayed

Dr. Ahmed Zayed holds a baccalaureate of Medicine and Surgery. He has completed his degree at the University of Alexandria, Egypt. Founder of ZayedMD, Dr. Ahmed believes in making the knowledge as accessible as possible to patients. He had his work featured in reputable publications such as The Huffington Post. Other than his passion for writing, Dr. Ahmed spends​ his time outside the hospital at the gym or with a good book.

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