What is stress incontinence?
Stress incontinence is the inability to control your urge to urinate in certain circumstances. It’s a serious and embarrassing disorder and can lead to social isolation. Any pressure placed on the abdomen and bladder can lead to the loss of urine.
It’s important to remember that the term “stress” is used in a strictly physical sense when describing stress incontinence. It refers to excessive pressure on the bladder and not emotional stress.
An overactive bladder is a separate condition. In some cases, both overactive bladder and stress incontinence can occur, which is called mixed incontinence. Your doctor can do tests to determine which is causing your incontinence.
Your bladder is supported by a system of muscles:
- The sphincter encircles the urethra, the tube that carries urine outside of your body.
- The detrusor is the muscle of the bladder wall, which allows it to expand.
- The pelvic floor muscles help support the bladder and the urethra.
To hold urine inside your bladder without leakage, you need to be able to contract your sphincter. When your sphincter and pelvic muscles are weak, it’s more difficult to contract these muscles and the result is stress incontinence.
The main symptom of stress incontinence is the loss of bladder control during physical activity. You may experience a few drops of urine or a large, involuntary flow. This can happen while you are:
- doing heavy lifting
- engaging in sexual intercourse
Sometimes even standing up from a seated or reclining position can put additional pressure on your bladder and cause a leakage. Stress incontinence is unique for every individual. You may not show symptoms every time you participate in an activity, and the same activities that cause leakage for you may not affect another person with stress incontinence.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), women are twice as likely as men to suffer from involuntary leakage. The most common causes of stress incontinence among women are pregnancy and childbirth, especially having multiple vaginal deliveries. During pregnancy and childbirth, the sphincter and pelvic muscles stretch out and are weakened.
Older age and conditions that cause a chronic cough can also cause stress incontinence. This condition can also be a side effect of pelvic surgery.
Some women only suffer from stress incontinence during the week before they get their period. The NIDDK explains that estrogen drops during this phase of the menstrual cycle, which can weaken the urethra. This is not common though.
Other risk factors for stress incontinence include:
- smoking due to chronic cough
- any other condition associated with chronic cough
- excessive caffeine and alcohol use
- long-term participation in high-impact activities
- hormonal deficiencies
Treatment for stress incontinence varies according to the underlying cause of your problem. Your doctor will help you come up with a treatment plan using a combination of medications and lifestyle adjustments.
You can change your lifestyle and the way you live to reduce episodes of stress incontinence. If you’re obese, your doctor may advise you to lose weight. You might also try to avoid activities that cause leakage, such as jumping or jogging.
Nicotine can irritate your bladder and may contribute to incontinence. If you’re a smoker, you should quit. The constant cough seen in smokers also contributes to the problem. Also, consider avoiding caffeine and alcohol, because these substances are bladder irritants. You might want to cut back on your overall fluid intake to reduce bladder pressure.
Pelvic muscle training
For many women, pelvic muscle training can help treat stress incontinence. Kegel exercises make your sphincter and pelvic muscles stronger. To perform a Kegel, contract the muscles you use to stop a stream of urine. It can be helpful to practice doing Kegels while sitting on the toilet to help you learn which muscles to use. Once you have mastered the exercise, you can perform them anywhere and at any time.
Electrical stimulation is another treatment, and it sends a mild electrical current through your pelvic floor muscles. The current makes your muscles contract, mimicking a Kegel exercise. You may be able to contract the muscles yourself after feeling exactly which muscles are contracting.
There are currently no FDA-approved medications to treat stress incontinence. Both oral and topical estrogen supplements may help in women. Sometimes, pseudoephedrine is used with success. The FDA is evaluating Cymbalta, an antidepressant, which seems to show promise in treating stress incontinence.
If you have a severe case of stress incontinence, to the point that it interferes with your everyday life, your doctor may recommend surgery. Several types of procedures are available and include vaginal repairs and other procedures to lift the bladder and urethra. These surgeries are being perfected on an ongoing basis and a qualified surgeon can explain your many options.
During the surgery, doctors will try to provide your urethra and bladder with more support. A sling procedure uses your own tissues to create a support structure for the urethra. The Mayo Clinic states that slings are used more often in women than in men.
Your urologist, a doctor who specializes in the urinary tract, may also choose to inject collagen directly into the supportive tissues of your urethra. This strengthens the sphincter muscle by increasing pressure on the urethra. Collagen injections are the least invasive surgical procedure to treat stress incontinence.
There are many ways to treat stress incontinence, depending on the severity of your condition. If you experience urine leakage while moving or exercising, see your doctor. There is no need to suffer the embarrassing consequences of incontinence in silence.