What is stress incontinence?
Stress urinary incontinence is the unintentional leakage of urine. Stress incontinence happens when physical movement or activity such as coughing, sneezing, laughing, exercising or heavy lifting puts pressure or stress on the bladder. It is not related to psychological stress.
Stress incontinence occurs when the muscles and other tissues that support the bladder become weakened. Childbirth can cause the pelvic floor muscles and urinary sphincter to lose strength. Other factors that increase the risk of developing stress incontinence include physical changes associated with age, obesity, hysterectomy and pelvic floor surgery. Factors that may worsen stress incontinence include illnesses that cause chronic coughing or sneezing, smoking, excess consumption of caffeine or alcohol, high-impact activities and hormonal deficiency.
How can one manage stress incontinence?
Many people struggle with stress incontinence. It is not something you should feel embarrassed to discuss with your doctor. In many cases, patients can benefit from more than one option, giving them the ability to find the best solution for their individual needs. You and your doctor should discuss the treatment options available. These include behavior therapies, medication, devices and surgery.
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Behavior therapies that can help with incontinence include pelvic floor muscle exercises, biofeedback, neuro-stimulation, decreasing consumption of caffeinated beverages and alcohol, quitting smoking, losing excess weight, treating a chronic cough and scheduling regular toilet trips.
Duloxetine is a medicine that is usually used to treat depression. However, it can help with stress incontinence by interfering with certain chemicals that are used in transmitting nerve impulses to muscles. This helps the muscles around the urethra contract more strongly.
Certain devices designed for women may help control stress incontinence, including vaginal pessary (shaped like a ring with two bumps that sit on each side of the urethra) and urethral inserts (small tampon-like disposable device inserted into the urethra that acts as a barrier to prevent leakage).
Surgical interventions for stress incontinence are designed to improve closure of the sphincter or support the bladder neck. Surgical options include injectable bulking agents, retropubic colposuspension, inflatable artificial sphincter and sling procedures (surgical mesh).
Transvaginal sling with mesh is the most common procedure performed in women with stress incontinence. In this procedure, the surgeon either uses the patient’s own tissue, donor tissue or synthetic material (mesh) to create a sling or hammock that supports the urethra. Research suggests that the complications are infrequent and rarely require follow-up surgery.