Stress Urinary Incontinence

Stress urinary incontinence is an accidental leakage of urine through the urethra.  Certain activities like coughing, sneezing and heavy lifting put pressure or stress on the bladder resulting in spontaneous unintended passage of urine.  Stress urinary incontinence is more prevalent in women than in men.  Stress urinary can be very embarrassing and prevent you from leading a normal social life.

What are the symptoms?

People suffering with stress incontinence have urine leakage during normal activities such as coughing, sneezing, laughing, during exercise, etc.  They may not experience it on every occasions, however, any activity that puts stress on the bladder can result in accidental urine leakage, especially when the bladder is full.

What are the causes?

Stress incontinence is caused by weakening of the pelvic floor muscles that support the bladder and urinary sphincter which controls the passage of urine.  When the bladder is full urinary sphincters (valve-like muscles) close down to prevent accidental leakage of urine, however, due to weakening they are not able to stay closed.  This weakening is caused by age, prostate surgery in men and childbirth in women.

What tests will be required for diagnosis?

Apart from medical history and physical exam, there are a few procedures carried out to check the bladder pressure and flow of urine.  They include,

  • Neurological exam to check pelvic nerve problems
  • Urinary stress test
  • Urodynamic test

Tests of bladder function

  • Measuring post-void residual urine: This test is done to check for bladder function if you are not able to completely empty the bladder during your visit to the bathroom. This may be due to old age, previous bladder surgery, or diabetes.
  • Cystometry: This procedure is done to check bladder pressure while filling and emptying the bladder.  People who have neurologic disease especially need this procedure to check for pelvic nerve function.
  • Video Urodynamics: This procedure creates images of the bladder while filling and emptying.
  • Cystoscopy: This procedure is done to visualise the bladder and urethra with a cystoscope inserted into the bladder.
What are the treatment options available?

While there are no medications approved for the treatment of stress urinary incontinence, there are a number of other strategies to lessen the incidences of urinary stress incontinence.  If urinary tract infection is found to be a contributing factor, then antibiotics are prescribed to treat urinary tract infection which in turn will reduce the incidences of urinary stress.

  • Behavior therapies
    1. Pelvic floor muscle exercises: These are called Kegel exercises. They are recommended to strengthen the pelvic floor muscles and urinary sphincter. Kegel exercises done together with biofeedback prove more effective as it uses electrical stimulation to target precise muscle contractions.
    2. Fluid consumption: Limiting the amount of fluid that you drink during the day and having it only at particular times of the day can reduce stress incontinence to a large extent. Cutting down on intake of alcohol and caffeine can also result in significant improvement
    3. Healthy lifestyle changes: Smoking cessation, weight loss and treating cough can reduce the incidences of urinary stress incontinence.
    4. Bladder training: Making a timetable for toileting (bladder training) and going to the toilet immediately again after you have emptied your bladder (double voiding) also reduces the risk of accidents.
  • Medications

There is no specific drug for treating stress urinary incontinence, although an antidepressant Duloxetine can help with symptoms of stress incontinence. However, symptoms return almost immediately on stopping the drug.