Stress Incontinence - Causes, Symptoms, Risk Factors, and Treatment

What Is Stress Incontinence?

Stress incontinence is a condition that causes an inability to control the urge to urinate under various circumstances. This condition arises mainly due to the stress on the abdomen, which puts pressure on the bladder. It is not stress in the physical sense.

Stress incontinence usually occurs during coughing, sneezing, laughing, and exercising. The condition is common in females, especially old-aged females, and females of childbearing age. Surgical intervention, pelvic floor exercises, or kegel exercises can control stress incontinence. Stress incontinence often leads to mental trauma for patients due to the feeling of embarrassment and social isolation.

What Are the Symptoms of Stress Incontinence?

• Urine leakage is due to pressure on the bladder or urethra.

• Urine leakage while coughing, sneezing, laughing, exercising, or carrying heavy weight.

• Urine leakage while standing, bending over, or having sex.

What Are the Risk Factors Associated with Stress Incontinence?

Stress incontinence is often linked with various risk factors, such as:

• Obesity.

• Diabetes (high blood sugar).

• Menopause (natural decline in women’s reproductive hormones in their 40s or 50s).

• Hysterectomy or pelvic surgery (surgical removal of uterus and cervix).

• Uterine prolapse (weakening of pelvic tissues and muscles).

• Pregnancy and childbirth.

• Lower back or pelvic floor nerve injury.

• Surgery for enlarged prostate or prostate cancer.

• Chronic coughing.

How Is Stress Incontinence Diagnosed?

The doctor diagnoses stress incontinence by examining the patient physically and asking about their symptoms. The patient is asked to maintain notes about fluid intake, urination, and urine leakage for at least two to three days to make the diagnosis. Some of the diagnostic tests for stress incontinence are as follows:

• Urinary Pad Test: An absorbent pad is worn at home for 24 hours to measure the volume of leaked urine.

• Bladder Scan: This ensures the person can empty their bladder while urinating.

• Urinalysis: It is a urine test that determines any signs of infection in the urine sample, such as hematuria (blood in urine) or UTI (urinary tract infection).

• Cystoscopy: It is an endoscopy of the urinary bladder through the urethra.

• Ultrasound: It is an abdominal or pelvic ultrasound that accesses kidneys, bladder, and other organs.

• Urodynamic Testing: This test helps diagnose how much urine is held back in the bladder after peeing. It analyzes how the urinary system of an individual holds and releases urine.

How Is Stress Incontinence Treated?

Treatment for Women:

• Vaginal estrogen gels, creams, patches, or rings are prescribed to strengthen vaginal tissues and muscles after menopause.

• Urethral injections keep the sphincter close by bulking up the ureter muscle.

• Insertion of vaginal devices, such as pessary (removable) devices to support bladder and urethra.

• Placing a sling surgically under the urethra to provide support. This sling comprises one’s tissues, surgical mesh, or donor tissue.

Treatment for Men:

Stress incontinence in males often occurs post-surgery for prostate cancer, and treatment includes:

• A surgical sling (mesh) is placed to support the upper part of the urethra, called a urethral bulb.

• Texas catheters or condom catheters are used to cover the penis for draining urine into the bag. This method is used to tackle urine leakage, but it does not prevent it.

• Surgical placement of artificial sphincter devices to keep the urethra closed. One needs to press the pump to open the device and pee.

What Are the Various Types of Surgeries for Stress Incontinence?

Surgeries for stress incontinence include:

• Sling Surgery - It is a common surgical procedure in which a sling is used to support the urethra. The sling is made up of synthetic material or derived from one’s body tissues. The patient usually recovers and returns to daily activities within two to six weeks.

• Tension-Free Slings - It is a mesh-like structure derived from a synthetic material like polypropylene. The sling supports the urethra and is stabilized by the body tissues rather than the stitches. The healing is complete only after scar tissue forms in and around the mesh to prevent it from moving. The surgeon might recommend one of the following approaches to carry out the tension-free sling procedure:

  • Retropubic Procedure - This is done by making a small incision into the vagina to access the urethra. Also, two small incisions are made above both sides of the pubic bone. The surgeon uses a needle to pass each end of the sling from the vagina to the abdomen. The soft tissues hold the sling in position. The vaginal incisions are closed with absorbable sutures and sealed with glue or stitches.

  • Transobturator Procedure - In this, a small incision is made in the vagina and on both sides of the groin. It is similar to the retropubic one, but the only difference is that the mesh passes through the groin muscles rather than the abdominal walls.

• Conventional Slings - This surgical procedure uses body tissues to support the neck of the bladder. The doctor collects the tissues from the abdomen or the thighs to form a sling. The doctor makes an incision in the vagina and places the sling beneath the urethra. The sutures are placed on each end of the sling to the abdominal wall. Conventional slings mainly require an incision that is more extensive than the tension-free sling. Therefore, the patient might need to stay in the hospital for a day or two until the recovery is complete. One might also require a catheter after the surgery until the healing is complete. A conventional sling procedure is also associated with difficulty in emptying the bladder. Therefore, this procedure is mainly reserved for females who have undergone incontinence but still suffer from urinary incontinence.

• Suspension Procedure - This procedure mainly supports the urethra and bladder neck by lifting the tissues around them. In this procedure, an incision is made in the lower abdomen. The doctor attaches one end of the thread to the outer vaginal wall and the other to the ligament near the pelvic bone. When the sutures become tight, the vagina shifts upwards to support the bladder neck.

Conclusion

Stress incontinence is often embarrassing for the person due to urine leakage, which usually occurs due to various circumstances and medical conditions. Therefore, one must feel free to consult the healthcare provider for proper diagnoses and management of stress incontinence to improve their quality of life.