Stress incontinence is the leakage of urine out of the bladder when you jump, cough, sneeze, laugh, lift a heavy object, have sex, or do anything else that puts pressure on the bladder. Often only a small amount of urine leaks out, although in more severe cases, the pressure of a full bladder overcomes the body’s ability to hold in urine.
Stress incontinence occurs when the urethral sphincter, the pelvic floor muscles, or both of these structures have been weakened or damaged and can’t dependably hold in urine. This can happen due to:
- injury to the urethral area
- surgery in the pelvic area, including prostate surgery in men
- some medications
Stress incontinence is the most common type of incontinence in women.
Diagnosing stress incontinence
To identify any problems that might be causing incontinence, your doctor will ask you to describe your symptoms in as much detail as possible. You might be asked to keep a diary of urinations and fluid intake for a few days. Your doctor will also want to know about all surgeries, pregnancies, and medications you are taking, since certain drugs can cause incontinence by increasing urine production or relaxing muscles of the bladder or urethra. A physical exam will include a genital exam for men, a pelvic exam for women, and a rectal exam for either sex. Other tests may include:
- urinalysis to check for a urinary tract infection
- urinary stress test (standing upright with a full bladder and then coughing)
- a post-void residual test to measure the amount of urine left in the bladder after you urinate
- cystoscopy to look inside the bladder
- pelvic or abdominal ultrasound
- tests to measure pressure and urine flow
- an x-ray to look at the bladder and kidneys
Treating stress incontinence
Treatment choices for urinary incontinence range from lifestyle changes to surgery. The right treatment for you depends on what is causing your stress incontinence and your preferences for treatment. Keep in mind that no treatment works perfectly, and you may have to try more than one approach before you find the one that best suits your needs. Women and men may need different treatments for the same thing.
Treatments for stress incontinence include:
- fluid management. This means drinking less fluid during the day, which lets the bladder handle less fluid.
- pelvic floor physical therapy. Basic pelvic muscle exercises are called Kegel exercises. They involve identifying the pelvic muscles (pretend you are trying to avoid passing gas), contracting them for a few seconds, relaxing, repeating 10 or more times, and doing this several times a day. Some women find that using vaginal weighted cones helps boost the power of their pelvic floor exercises.
- biofeedback. A biofeedback device can help you identify pelvic floor muscles and learn to strengthen and control them.
- electrical stimulation. Using an electrical stimulator at home can help men and women who aren’t able to effectively exercise their pelvic floor muscles. The device delivers a small electric current that makes the pelvic muscles contract painlessly.
- medications. Alpha-adrenergic agonists such as phenylephrine and pseudoephedrine and antidepressants such as amitriptyline and imipramine ease stress incontinence in some people.
- surgical procedures. When lifestyle changes and other less-invasive treatments don’t work, procedures such as the urethral sling, bladder neck suspension, or implantation of an artificial sphincter can stop stress incontinence.
- injection of bulking agents. The injection of tiny beads or particles suspended in gel around the urethra can help men who have had their prostates removed and women with the type of stress incontinence known as intrinsic sphincter deficiency, in which the urinary sphincter no longer closes completely and allows urine to leak out, particularly with exertion.
10 Common Reactions to Urinary Incontinence that Impede Care-Seeking
Our lives are a dynamic flurry of family and professional activities — our work, our families and friends, and duties on the home front. Some of us have additional challenges due to ill health, financial stress, elder care or marital breakdown. When small urine leaks begin to appear every now and then, they might feel like a nuisance amid the noise of everyday life. Research tells us that women wait about five to 10 years to seek assistance for urinary incontinence.
Our beliefs about the problem are important because they influence how and when we take action. The following are 10 common reactions that deter or delay sufferers, especially women, from seeking professional advice or assistance for the problem:
- It’s a private problem. When sufferers say “incontinence is private,” they reveal their feelings of vulnerability, embarrassment or shame about the condition. While these emotions are normal reactions to urinary problems, they also evoke the desire to draw inward in self-protection (Hagglund & Wadensten, 2007).
- Urinary problems are hereditary. Sufferers are discouraged from seeking assistance when urinary changes are viewed as an inherited problem. Why heredity beliefs discourage sufferers from seeking care is not well understood — in fact, many health problems that are inherited (consider diabetes and heart disease) benefit from medical care.
- Incontinence is a normal part of aging or childbirth. Some women believe urinary leakage to be “part and parcel of what it means to be a woman (Peake, Manderson & Potts, 1999).” The changes in urination are “normal” because they emerge around the time of pregnancy, labor and delivery.
- My health care provider should start the conversation. All of us avoid difficult topics by waiting for others to raise an issue for discussion, and our relationship with our doctors is no different. When it comes to urinary health issues, women expect their health care providers to start the conversation (Peake, Manderson & Potts, 1999).
- All women leak a little when they laugh. When women in their 40s and 50s get together in groups, at least one will make a joke about the leakage that ensues with all that laughter! This lightheartedness helps to defuse embarrassment, but it also suggests a kind of universality to these experiences. The belief that all women leak a little while laughing normalizes the problem, but it also perpetuates the view that professional care or advice is not necessary.
- Urine leaks are a minor problem that I cope with on my own. When urine leaks first appear, initial concerns are given to whether others see or smell it. Pads are quick, easy, and very familiar territory for menstruating women, and so they are a practical solution. Other lifestyle changes also follow (e.g., restricting water intake, avoiding certain sports). Mild to moderate leaks often are managed using lifestyle changes before seeking any professional advice (Dowd, 1991; Skoner & Haylor, 1993).
- I can’t deal with it. There’s no question that the appearance of urine leaks can be an emotional event that women just want to forget about (Skoner & Haylor, 1993). It’s hard to make sense of what happened, and these circumstances can threaten how sufferers see themselves and their future.
- My doctor will want me to have surgery. Many women express reluctance about seeking professional care because they are afraid that the doctor will recommend something they aren’t ready for — like surgery (Skoner & Haylor, 1993).
- My doctor told me to just get used to it. When doctors respond with cynicism, so do we. Such interactions can set us back on our path to health and wellness, but only if we let it. Family physicians have acknowledged their own struggles to provide optimal care due a lack of knowledge about the effectiveness and availability of treatment options (Teunissen, van den Bosch, van Weel, & Lagro-Janssen, 2006).
- Other health issues are a priority for me. Research tells us that when it comes to urine leaks, women prioritize other health issues as more important. Women can “lower” its priority by choosing to reveal the urine leakage after the doctor’s visit — like while walking out of her office — or by sharing a list of health concerns while inwardly hoping the doctor will pick “urine leakage” from the list (Teunissen, van den Bosch, van Weel & Lagro-Janssen, 2006).
While changes to a woman’s body may be inevitable during the cycle of life, beliefs that they cannot be changed reveal our low expectations about the body’s resiliency and capacity. Professional assistance in the early stages of urinary incontinence can be a useful way to learn more about the health of the bladder and pelvic floor, and how to optimize its function.
Options for treatment of urinary incontinence include acupuncture, urinary rehabilitation, behavior therapy (“bladder training”), pelvic floor physiotherapy and medication. Medical assessment is helpful to rule out any underlying health risks and provide clarity about the type of urinary leakage that sufferers experience.
First Vaginal Insert for Fecal Incontinence Clears FDA
The US Food and Drug Administration (FDA) has cleared for marketing the Eclipse System (Pelvalon, Inc) for treatment of fecal incontinence (FI) in adult women who have had four or more FI episodes in a two-week period.
The device includes an inflatable balloon, which is placed in the vagina. When inflated, the balloon puts pressure through the vaginal wall onto the rectal area, thereby reducing the number of FI episodes.
The device is initially fitted and inflated by a clinician. After proper fitting, the patient can inflate and deflate the device at home as needed. The device should be removed periodically for cleaning.
FI is a common problem, particularly among older women. Risk factors include pregnancy, childbirth, or nerve or muscle damage in the pelvic region.
“Current treatment options for fecal incontinence include drugs, dietary changes, exercise, and surgery,” William Maisel, MD, MPH, deputy director for science and chief scientist in the FDA’s Center for Devices and Radiological Health, said in an FDA news release. “The Eclipse System provides an additional treatment option for women who suffer from this condition.”
The FDA reviewed data for the Eclipse System through the de novo classification process, a regulatory pathway for some low-to-moderate-risk medical devices that are not substantially equivalent to a legally marketed device.
The data included nonclinical testing and a clinical trial involving 61 women with FI treated with the device. After one month, almost 80% of women in the study experienced a 50% decrease in the number of FI episodes while using the device, as compared with baseline, the FDA said.
Adverse events associated with the device included pelvic cramping and discomfort, pelvic pain, vaginal abrasion, redness, or discharge, as well as urinary incontinence. All device-related adverse events were mild or moderate, and none required any significant intervention.
The women in the study found the insert to be “comfortable, and uniformly said they would recommend it to a friend,” the company said in a news release.
“It is so exciting that a new low risk approach for treatment has proven to be so effective for women suffering from loss of bowel control, and the Eclipse System is clinically demonstrated to be exactly that,” Holly E. Richter, PhD, MD, director, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, and immediate Past President of the Society for Gynecological Surgeons, said in the company release. Dr Richter led the pivotal study of the Eclipse System.
“Fecal incontinence is a truly devastating condition, and many women in my practice have tried every existing treatment without success. Eclipse offers hope to these women, of immediate bowel control as well as greatly restored confidence and freedom,” she added.
The company said the Eclipse System will be available later this year.