What is Stress Incontinence?

Incontinence describes any accidental or involuntary loss of urine from the bladder or loss of faeces from the bowel.

Though you may not have heard of the phrase “stress incontinence”, a large proportion of people with incontinence suffer from this type of the condition. Stress incontinence is the most common form of incontinence, with an estimation that around 1 in 5 women over the age of 40 suffer from it. Studies examining the prevalence and distribution of the different types of incontinence in women have shown that 49% of those affected have stress urinary incontinence, 21% have urge incontinence and 29% have mixed incontinence. Although stress incontinence is common in women due to effects of menopause and childbirth, both women and men can suffer from stress incontinence.

What are the main causes of Stress Incontinence?

Stress incontinence occurs when the muscles and other tissues that support the bladder and regulate the release of urine weaken. The Ureter, the tube that carries urine out of your body should stay closed as the bladder expands. However, when those muscles are weakened, exerting force on the abdominal and pelvic muscles can cause urine leakage. When professionals calculate the likelihood of individuals having stress incontinence, the most important risk factors are thought to be age, a person’s history of pregnancy, childbirth and obesity. In women, poor function of pelvic floor muscles or the sphincter may occur because of tissue or nerve damage during delivery of a child. Interestingly, the relationship between childbirth and stress incontinence has been studied greatly by researchers in the recent years. It is even thought that the way a child is conceived can have an impact on the likelihood of stress incontinence occurring. In 2004, Groutz followed 363 women for 1 year after childbirth to examine the link between the type of childbirth and the incidence of stress incontinence. All of the study subjects denied a history of stress incontinence prior to pregnancy. The incidence of stress incontinence was 10.3% in women who had a vaginal delivery, 12% in women who had a caesarean section due to obstructive vaginal delivery and 3.4% in women who had an elective caesarean section.

If you have stress incontinence, you will find that you leak during exercising. Specifically, people with stress incontinence find they leak when jumping. Many people find jumping on a trampoline specifically causing accidents.

What can you do to treat Stress Incontinence?

The ideal method of treatment for you depends on the severity of your stress incontinence and how your symptoms affect your life. However, the main methods of treatment people use are the following:

Pelvic Floor Muscle Exercises

Recommended for: Those with any level of stress incontinence who are strong enough to tighten their pelvic floor muscles

Before you look for an extreme and expensive solution to tackle stress incontinence, trying simple Kegel exercises may be an easier place to start. Kegel exercises help to strengthen your pelvic floor muscles and urinary sphincter. Although Kegel exercises have been proven to be effective, the likelihood of them working for you depends on how regularly you perform them. If you are considering doing Kegel exercises on a regular basis, a Doctor or a physical therapist can help you to learn how to do them correctly. Exercising the pelvic floor muscles is often recommended by Doctors as the first line of cure as it is the least invasive method. Strengthening of pelvic floor muscles by exercises results in a significant increase of pelvic floor muscle strength and reduction of stress incontinence symptoms. The exercises lead to an improvement or a complete cure of the condition in 80-85% of cases.

When practising your Kegel exercises, you should firstly ensure you have found the right muscles. To identify your pelvic floor muscles, try and stop urination in midstream. The muscles you are tightening in this exercise are pelvic floor muscles. It is recommended by experts to hold this contraction for five seconds, then relax for five seconds. You can try this up five times in a row, and work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds in between contractions. Al take 4 to 8 weeks of daily exercise for you to notice an improvement.

Surgery                                             

Recommended for: Those who have severe stress incontinence and do not see results in any other method

If your stress incontinence has become severe and you are looking for a last-minute resort, surgery can be a highly effective and durable option. A Urologist or Doctor who specialises in incontinence treatment will recommend the ideal surgery method for your situation.

One common method of surgery for men and women is a sling procedure. It is estimated that 8 out of 10 women are cured after bladder sling procedures, making the surgery an effective solution for treating stress incontinence. Sling procedures for women involve making an incision in your lower abdomen and vagina so a sling can be placed around the neck of the bladder. This effectively supports it and prevents accidental urine leaks. Slings are created from muscle, ligament or tendon tissue. In some cases, the sling may also be composed of synthetic material such as plastic that is compatible with body tissues or of an absorbable polymer. During the procedure, a sling is placed around the urethra to lift it back into a normal position and exert pressure on the urethra to aid urine retention. The sling is then attached to the abdominal wall. A bladder procedure helps close your urethra and bladder neck, a part of the bladder that connects to the urethra. To allow the urinary tract to heal, a thin, flexible catheter is placed into the bladder through the urethra or belly wall to allow urine to drain.

A woman named Jan who suffered from stress incontinence recently told her story of getting a sling procedure in femalehealthissues.com. She explained, “women like me who have had multiple pregnancies are very prone to it.” Jan reports how a health visitor recommended doing lots of exercises and she was sent to a physiotherapist who specialised in using a biofeedback technique. Jan noticed slight progression at home six weeks after doing her pelvic floor exercises several times. However, the real change happened when Jan’s manager explained that all she had to do was get surgery for the problem to go away. Jan finally decided that surgery was the best option, and decided to have a sling procedure to prevent leakage of urine whenever it was put under pressure. This was all done through the vagina rather than the abdomen, so it was not long before Jan was up and about again.  She asserted, “I was scared at first that it would be temporary, but my stress incontinence seemed to have gone. Now, 4 years later, I am really pleased that I had it done”.

In the male sling procedure, synthetic mesh-like surgical tape is positioned around part of the urethral bulb, which compresses the urethra and moves it into a new position. Many men find this method to be a less invasive method when compared to other surgeries. The procedure involves placement of a synthetic mesh in the groin area to compress the urethra under it. Most patients have their catheters stay in overnight and can be removed in the hospital in the case of an overnight stay. The sling suspension requires permanent sutures in the perineum and may create some pain in the immediate post-operative period. Incisions are made through the perineal tissue to reach the positioning of a supportive sling.

A similar method of treatment is a tape procedure, which is a procedure designed for women. In this procedure, a piece of plastic tape is inserted through a cut inside the vagina and threaded behind the tube that carries urine out of the body. The middle part of the tape supports the urethra, and the two ends are threaded through two incisions in either the tops of the inner thigh or the tummy. It is reported that two in every three women do not experience any leaking afterwards. By holding the urethra up in the correct position, the piece of tape can help reduce the leaking of urine associated with stress incontinence.

Another common type of surgery that has a high success rate is a urethra bulking agent. This option is particularly ideal for women who are not fit enough for extreme anaesthesia. It is also often recommended for women who’s stress incontinence is due mainly to a deficiency in the sphincter muscle surrounding the urethra. A bulking agent is a material that is injected around the urethra, narrowing the urethra so leakage is less likely to occur. Bulking agents increase the size of the lining of the urethra, which creates resistance against the flow of urine. Common bulking agents include collagen and water based gels containing various different agents. In the procedure, a bulking agent is injected around the urethra just below the neck of the bladder via a cystoscope or specially designed syringe. Following the bulking agent your doctor may check you are emptying your bladder adequately using a scanner or a catheter. It is estimated that 60-70% of women undergoing urethral bulking will notice cure or improvement of their SUI symptoms.

A more extreme method of treatment for men and women is an artificial sphincter treatment method. Although effective, many people are discouraged from this method as they feel it is invasive. During this procedure, an artificial sphincter, a device made of silicone rubber is used. The sphincter has an inflatable cuff that fits around the urethra close to the point where it joins the bladder. When you need to urinate, the cuff is deflated, allowing urine to drain out. Artificial sphincter placement has been found to be a successful treatment method for up to 90 out of 100 men who have incontinence after prostate removal. Before this device is implanted however, the patient must have severe symptoms and have failed all other treatments and surgical approaches.

Electrical Stimulation

Recommended for: Those who are too frail or weak to contract their pelvic floor muscles

Electrical stimulation is often referred to as pelvic floor muscle electrical stimulation or functional electrical stimulation. This method of treatment for stress incontinence has been proven to be effective, with cure and improvement rates ranging from 60 to 90%.  Electrical stimulation is particularly ideal for those who are too frail or weak to contract their pelvic floor muscles. Although successful, application of this treatment is not common due to little physiological and technical information. Electric Stimulation involves the stimulation of levator ani muscles using painless electric currents. When the pelvic floor muscles are stimulated, the levator ani muscles and urinary sphincter contract. A pulsed current is the type of current most commonly used in electrical stimulation of the pelvic floor muscle or bladder.

Your Doctor should advise you on how long your sessions of electric stimulation should last for. This will depend on your health and the severity of your incontinence. Electrical muscle stimulation can be done in your Doctor’s office or the privacy of your own home with a muscle stimulation device.

Practice Bladder Retraining

Recommended for: Cognitively and physically able adults with moderate stress incontinence to regain continence

Bladder retraining involves building up the amount of urine you can hold in your bladder in a supported way to increase your bladder’s strength. A case study in 1993 found bladder training to be a safe and effective treatment in the management of mild to moderate forms of stress incontinence. One of the reasons so many people choose to practice bladder retraining is that it does not hurt and it is not invasive. Bladder retraining is effective through reaching the toilet just in time, however in situations where you can not do this, there may still be leaking until you have practised a lot. Along with practising bladder retraining, you can ask your Doctor to recommend other behavioural techniques to achieve the best results.

Healthy lifestyle options such as quitting smoking, losing excess weight or treating a chronic cough will lessen your risk of stress incontinence as well as improve symptoms. Stress incontinence can have an impact on the way you live your life and can prevent you from doing activities you once enjoyed. However, when your goals are accomplished through treatment methods, you will regain confidence that you will control the act of urinating!