Stress Incontinence: Overview and More

2022-07-30 18:32:34 By : Ms. Stella Lee

Brandi Jones MSN-Ed, RN-BC is a board-certified registered nurse who owns Brandi Jones LLC, where she writes health and wellness blogs, articles, and education. She lives with her husband and springer spaniel and enjoys camping and tapping into her creativity in her downtime.

Jay Yepuri, MD, MS, is a board-certified gastroenterologist and a practicing partner at Digestive Health Associates of Texas (DHAT).

Stress urinary incontinence (SUI) is a type of incontinence that causes urine (pee) to leak when physical movements put pressure on your bladder. These movements may include exercising, sneezing, coughing, or lifting. Stress incontinence occurs because the muscles that support the bladder and urethra are weakened or damaged. Treatment ranges from symptom management to surgery. 

The brain and bladder control urination. The bladder stores urine and the pelvic floor muscles hold the bladder in place. The bladder is connected to a tube called the urethra that leads to the outside of the body. 

When the bladder is full, the brain sends a signal telling it to release urine, and urination occurs. The muscles in the bladder contract and the sphincter muscles around the urethra relax and open. Urine is pushed from the bladder and leaves the body by passing through the urethra.  

Urinary incontinence is sometimes called a bladder control problem. It occurs when a problem in the brain, muscles, or nerves causes urine to leak involuntarily. Types of urinary incontinence include:  

Stress incontinence symptoms include urine leakage with physical movements such as:

Urinary leakage from stress incontinence ranges from occasional small volumes (a few drops) to frequent larger volumes (a tablespoon or more).

Weak or damaged pelvic muscles and nerves make it hard for the bladder and urethra to hold urine. Physical movements place pressure on the bladder causing urine to leak. 

This damage to the nerves and muscles in the pelvic floor may be caused by multiple factors, including:

Stress incontinence is a symptom of damaged muscles and nerves in the pelvic floor. While it is more prevalent in older adults, it is not a normal part of aging.

The first step in finding the cause of your urinary leakage is to make an appointment with your primary care doctor. Your doctor will do a physical examination before determining the next steps in your diagnosis.

The doctor will ask questions and perform a physical examination that focuses on the urinary, reproductive, and nervous systems.

Your doctor may have you start a bladder diary if you aren't keeping one already. A bladder diary helps track daily patterns and symptoms and can help determine if stress incontinence is occurring. The diary should address the following questions:

A urinalysis tests urine for signs of a urinary tract infection or other underlying medical conditions that may cause incontinence. A urinalysis cannot determine if you are experiencing stress incontinence, but it can rule out other causes.

A one-hour pad test is done during an office visit with the doctor, while a 24-hour test is done at home. The pad is weighed after being worn for the designated time period. This gives the doctor information about the amount of urine that is leaking.

A bladder scan is an ultrasound test that shows how much urine stays in the bladder after urination. This can tell your doctor if you are experiencing urinary retention, which can be caused by urinary blockages, nerve issues, infections, or certain medications.

Your doctor may refer you to a urologist, a doctor who specializes in urinary tract diseases. A urologist may want to perform advanced tests such as a cystoscopy (a procedure that views the inside of the bladder using a thin camera) or urodynamic studies (tests that measure how well the bladder, sphincters, and urethra hold and release urine).

Treatment options for stress incontinence vary based on a person’s age, medical history, the root cause, the extent of the problem, and patient input. 

Symptoms can be managed with absorbent underwear, protective pads, diapers, or waterproof sheets to protect clothing and bedding from urine leakage.

Having regular bowel movements is essential because constipation can make incontinence worse. Prevention of constipation (difficulty eliminating stool) includes eating a diet with plenty of fiber, drinking six to eight glasses of water each day, and exercise.

Bladder training involves a fixed urination schedule that gradually adds time between bathroom breaks to increase the amount of fluid your bladder can hold.

Pelvic floor muscles are muscles that run from the pubic bone (pubis) to the tailbone (coccyx). They help support the bladder and urethra. Pelvic muscle training or rehabilitation, including the following, improves the muscle tone in the pelvic floor to help prevent leakage:

Excess weight is a risk factor for stress incontinence because it places extra pressure on the pelvic floor and bladder.

An example of a specialized device used for stress incontinence is a vaginal pessary. It is inserted in the vagina through an applicator to help support the urethra.

There are currently no medications approved by the Food and Drug Administration used to treat stress incontinence. However, off-label medications such as Proin (phenylpropanolamine) or Cymbalta (duloxetine ) may be prescribed.

Vaginal estrogen may be prescribed after menopause to decrease the risk of thinning urethral tissue. Some medications may be used to treat or prevent complications. For example, skin barrier creams protect the skin from breakdown caused by moisture from urinary leakage.

Bulking agents such as collagen are injected around the urethra under a local or general anesthetic.

Anytime a person experiences urinary leakage they should seek treatment. Even small amounts can be uncomfortable or cause problems.

Urinary leakage may be an indication of an underlying problem and can cause complications. For example, it can cause skin breakdown and increase the risk of urinary tract infections. However, there are many treatment options, and it is often reversible or curable.

Urinary incontinence can cause stress and embarrassment. Those who suffer from it often isolate themselves and avoid social interactions. However, there are many ways to treat and control stress incontinence so you can maintain a high quality of life. 

If you are waiting for a medical appointment or permanent treatment options, here are a few steps you can take now:

It can also be helpful to share insights from your experiences, as well as learn from others with similar concerns. The National Association for Continence (NAFC) offers message boards that provide a safe place to ask questions anonymously, express frustrations, give support, and share tips.

While discussing incontinence with your doctor may feel awkward, it is a common problem, and it’s important to seek medical advice. Any amount of leakage can be uncomfortable and cause problems such as skin breakdown or urinary tract infections. 

Stress incontinence can decrease your quality of life, especially if you are avoiding normal activities or social interactions due to urine leakage. Check with your doctor to find out which lifestyle changes and treatments may be right for you so you can get back to doing the things you love. 

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John Hopkins Medicine. Urinary incontinence in women.

Lugo T, Riggs J. Stress Incontinence. Treasure Island, Fl: Stat Pearls Publishing LLC.

National Association for Continence (NAFC). Stress urinary incontinence in women.

Urology Care Foundation. Stress urinary incontinence (SUI).

Tran LN, Puckett Y. Urinary Incontinence. Treasure Island, Fl: Stat Pearls Publishing LLC.

Medline Plus. Skin care and incontinence.

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