Stress incontinence is urine leakage that occurs during activities such as coughing, sneezing, laughing or exercise. The urethra, (the tube connecting the bladder with the outside), cannot withstand the increase in pressure caused by these activities and allows urine to escape.
Stress incontinence usually results from weak pelvic muscles, the muscles that hold the bladder in place and keep urine inside. It is is the most common form of urinary incontinence. It occurs in any age group but is more commonly seen in women between the ages of 40 and 60 years old.
Stress incontinence symptoms include the loss of urine when you are:
- Laughing, coughing or sneezing,
- Lifting an object,
- Standing or rising from a chair,
- Running or exercising,
- Involved in other types of physical activities.
Stress incontinence is diagnosed by bladder testing.
Exercise – In mild cases of stress incontinence your doctor may recommend specialized pelvic floor physical therapy. A trained therapist will work with you to help regain control of weakened pelvic muscles. The therapist may recommend using muscle stimulators or vaginal weights to maximize your muscle strength.
Vaginal Devices – A pessary is a stiff ring that is inserted by a doctor or nurse into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps reposition the urethra, leading to less stress leakage. Women of all ages can successfully use the pessary. This is an excellent alternative to surgery.
Surgical Procedures – In some women, the bladder can move out of its normal position, especially following childbirth. Different surgical techniques have been developed for supporting the bladder in its normal position. The two main types of surgery are retropubic suspension and the sling procedure.
- Retropubic suspension uses sutures (surgical threads) to support the bladder neck. The threads are secured to the pubic bone and other structures within the pelvis to form a cradle for the bladder. To place the sutures, the surgeon makes an incision in the abdomen a few inches below the navel.
- Sling procedures are performed through a vaginal incision. The conventional sling procedure uses a strip of material to support the bladder neck. The sling may be made of natural tissue or synthetic (man-made) material. Both ends of the sling are attached to the pubic bone or tied in front of the abdomen just above the pubic bone. Another sling method uses a synthetic tape, but the ends are not tied but rather pulled up above the pubic bone.
Injections – Bulking agents are a minimally invasive method of controlling stress incontinence. Materials such as bovine collagen or carbon beads are injected into tissues surrounding the bladder neck and urethra to add bulk and close the bladder opening — thereby reducing stress incontinence. The procedure is a simple one that can be done as an outpatient with minimal anesthesia. Over time, the body slowly eliminates the collagen, so you may need to repeat the injections.
Medicine – Currently, there are no medications available in the treatment of stress incontinence.