Stress Incontinence: Myths and Facts
Stress incontinence is involuntary voiding of urine while coughing, sneezing etc. Any task which will increase the intra abdominal pressure can precipitate incontinence including standing up, laughing, running and lifting weights. It is more common in women because of the greater number of injuries to the birth canal during child births.
It most commonly presents with dribbling of urine every time you cough or sneeze or lift weights. Even though you are aware of the dribbling, you will be unable to control it.
You may soil your clothes frequently and this may hamper your social life. You may start curtailing social visits and other outings and this may result in isolation and depression..
Stress incontinence can become a disabling disease with its social effects. Hence it is important to remain educated about this disease. The following are the answers to most common questions asked by people who suffer from stress incontinence.
What is the cause of stress incontinence?
The kidneys produce urine and this urine is stored in the bladder till a socially appropriate time when it can be voided out of the body. The control of urination is controlled at the level of spinal cord and the final control is achieved by a co-ordinated response between the urinary sphincters, the muscles of the pelvic floor and bladder muscle.
When urination is initiated the bladder contracts and along with it the urinary sphincter relaxes. During this time the muscles of the pelvic floor passively help by preventing the bladder from prolapsing.
Under normal conditions, the bladder remains relaxed and the sphincters constricted. A few slips of the pelvis muscle fibres, sling around the urethra anchoring it and also closing it shut.
In women child birth may cause injuries to the pelvic muscled. As a result they may lose their tone and become lax. This will affect the quality of the support they provide to the urethra. Apart from this, after menopause the vaginal and other supporting tissues of the bladder shrink to an extent because of lack of estrogens. This causes the bladder to lose support and sag. When this happens it is called a cystocele or urethrocele.
Other than this any prior pelvic surgery which has damaged any nerves or muscles will cause weakness of the pelvic muscles and hence incontinence.
What are the conditions that predispose to stress incontinence?
There are many conditions that increase the risk of having stress incontinence. These are listed below:
Traumatic child births: Traumatic child births are a common cause of stress incontinence in women who have delivered without assistance or in the underdeveloped world due to poor quality of maternal services. During birth damage can occur to nay of the muscles and they may tear. If these tears are not recognised and treated in time they will lead to stress incontinence.
Instrumentation during labour also increases the chances of incontinence. Application of forceps is particularly implicated.
Prior pelvic surgery: Similarly any prior pelvic surgery that has caused any damages to nerves in pelvis will cause weakness of the pelvic muscles and hence incontinence.
Obesity: Obesity increases resting intra abdominal pressures. This translates in to dribbling of urine with trivial tasks like standing up and so on.
Chronic cough: Any disease causing chronic cough can cause incontinence. Smoking is a common cause of chronic cough so is asthma.
Diabetes: Diabetes aggravated incontinence by damaging the pelvic nerves. It also causes excess urine to be produces and hence can aggravate the problem.
Consumption of excess alcohol/coffee: Alcohol and coffee cause excess urine to be produced. They will again exacerbate incontinence.
Will my urinary incontinence go away eventually?
Stress incontinence is not a incurable disease. If treated properly it will go away. Your doctor will be able to guide you further with the treatment approach for you, but broadly speaking lifestyle measure, medicines and surgery have all been studied and found effective.
What kind of tests might I need to determine the cause of my incontinence?
Once you report to your doctor, your doctor might want to ask some questions about this problem. He is likely to as you about how often you leak urine and the quantity of urine you leak every time. He will also want to know what activities cause this leak. Other information he might want include your fluid intake and your output. He will also ask you about any conditions that make your problem worse or better.
You should think of all these answers and keep them ready. Also carry a small note pad and pen to the consultation so that you can note down any important points. Also mention the impact of your disease on your social and work life. Let the doctor know about any other diseases you are suffering from or any medicines you take.
Once this is done a complete examination will be done by the doctor with particular emphasis of the abdomen and pelvis. During this time, pelvic examination may be necessary to evaluate the general condition of pelvic structures. He will do a neurological exam.
You will then require to go through a few basic blood tests to look for common co-existing diseases and a urine examination to look for protein, infection and traces of blood.
You will also need to undergo some specialised tests will measure bladder function. Measurement of post voiding urine volume is one such test. In this test the amount of urine in the bladder pre and post voiding is measure by means of ultrasound. Other tests include cystometry and video urodynamics.
How is this condition treated?
Initially this condition is managed by education and life style measures. You should limit your fluid intake to the amount recommended by your doctor. You should avoid alcohol and caffeinated drinks. Also schedule regularly pit breaks to go to the bathroom, this way you will have less urine in the bladder to dribble.
Lose any extra weight you are carrying and quit smoking. Weight loss is a very good way to manage stress incontinence. Also carry out pelvic floor exercises.
If these are not effective then one can use some devices like urogenital diaphragms which fit like tampons and are used during specific tasks. But these devices suffer from many disadvantages.
Will I need surgery?
Surgery is very effective in treatment of stress incontinence. In fact it is the only effective treatment if life style measure fails. Surgery generally aims to buttress the support of the bladder and strengthen the sphincters. During this procedure, redundant lax tissues are excised and the remaining tissues approximated to provide support to the bladder. Similarly the urethra is pulled up by using a sling and this help to kink the urethra while the bladder is relaxed thus preventing involuntary leak of urine. Alternatively bulking agents like collagen can be injected into the surrounding tissues to provide strength and support.
Presently inflatable balloon sphincters are also available which can be used to supplement a poor functioning sphincter.
How does my weight affect my condition?
As mentioned above weight plays a very important role in stress incontinence. Obesity increased the intra abdominal pressure at rest. Hence the pressure required to trigger a urine leak is much less in obese subjects.
Could pelvic floor exercises help me? How do I do them?
Pelvic floor exercises are a very good way to regain bladder control. These exercises tone up the pelvic floor muscles and the urinary sphincters. These exercises also make the supports of bladder taut and strong. All women must be encouraged to follow these simple pelvic exercises everyday during and after pregnancy for at least six months. This will prevent development of stress incontinence. Even in patients with established incontinence, pelvic floor exercises are very effective. Here are a few exercises you can try:
1. Do this in the half lying position, well supported with pillows, knees bent and feet flat. Place one hand under the back and other on top of the abdomen. Tighten the abdominal muscles and buttocks and press the small of the back down on the underneath hand. Breathe normally, hold for 10 sec and relax gently. Repeat up to ten times, Pelvic tilting can also be done sitting, standing or kneeling.
2. Sit, stand or half lie with legs slightly apart. Close and draw up around the anus to simulate holding defecation. Hold for 10 second and repeat again for up to 10 min. This exercise will build up the postural slow twitch fibres in the pelvic floor. All women should perform this exercise regularly during the ante-natal period, particularly after emptying the bladder.
What are the additional points that are of help?
Suffering from incontinence does not mean that you should cut off your social life altogether. With a little bit of planning you can do all those trips you wanted. Always carry a stock of supplies like towels and pads wherever you go. Also keep adequate dry underwear with you, if you have to change them. Do not drink too many fluids while travelling and pre mark your rest rooms on the way. This way you should be able to control your incontinence from coming in way of your social life.
Incontinence and sex: Women who suffer from incontinence may be embarrassed to talk about it with their partners hence their relationship suffers. But incontinence need not be a issue if women communicate effectively and you will be surprised at the number of men who will empathise with their partners.
Communicate freely and take your partner in to confidence. Empty your bladder prior to sex and avoid drinking fluids for an hour prior to sex. Women on top position will enable women to exert more control over their pelvic muscles. Also keep doing Keegel exercises to tone up your pelvic muscles.
Being incontinent is not a normal part of aging and not something that you just have to learn to live with. Treatments are available to cure incontinence or significantly reduce its effects on your life. So go ahead and take charge of your life.
For More Info On Treatments For Stress Incontinence Click Here