Urinary stress incontinence is defined as unintentional urine leakage caused by some kind of physical activity or movement, such as laughing, coughing, sneezing, exercising, or heavy lifting. These movements place pressure or stress on the bladder and cause urine to leak out. You may not experience incontinence every time you laugh or sneeze, for example, but any activity that increases pressure on your bladder, particularly when it is full, can cause the unintentional loss of urine.
Stress incontinence occurs because the muscles and fibrous tissue that support the bladder or control the release of urine may be weakened or function poorly. These tissues can lose their tone and strength due to a number of reasons, such as tissue or nerve damage incurred during childbirth, prostate surgery for men, obesity, diabetes, or lifestyle habits such as excessive smoking or alcohol consumption.
In this video, I describe in more detail what happens physically when you have stress incontinence.
As I explained in the video, treatment largely depends on the impact that stress incontinence is having on your lifestyle and your tolerance level for the problem. Some women may not be particularly bothered by it, while others feel embarrassed or uncomfortable and limit work and social life activities as a result, especially exercise and leisure activities. If you are troubled by stress incontinence, there are many treatment options that can help you manage this problem better and improve your overall quality of life.
In order to identify the best course of treatment for you, we typically conduct an initial evaluation, which usually includes a complete medical history, a physical evaluation, and a bladder symptom questionnaire.
In some cases, we will also obtain a bladder diary or perform a urodynamic exam during a second appointment. The urodynamic exam takes approximately 20 minutes and often helps us understand more precisely the cause of your bladder problem.
After your initial evaluation is complete, we will discuss with you the causes of your bladder problem and the best ways to treat it. Options for treatment may include some combination of the following:
- Pelvic Floor Exercises, known as Kegels, can strengthen the muscles that help support the bladder. We can train you to do these exercises correctly to regain and maintain continence. Some women have difficulty performing the exercises and either may benefit from devices placed into the vagina that make it easier to do the exercises or can work with a physical therapist.
- Behavioral strategies, such as managing the amount and timing of your fluid intake or scheduling more frequent trips to the bathroom to avoid the stress of an overly-full bladder, may be discussed with you.
- Healthy lifestyle changes can make a big improvement. Losing weight removes extra pressure on the bladder and the pelvic floor muscles; drinking and eating the appropriate amount of fluids and fiber can help avoid constipation and straining; and stopping smoking should reduce chronic coughing which can trigger incontinence.
- Medication can relax the bladder or tighten the sphincter muscles. Also, some medications you take for other conditions can affect your bladder control and should be discussed.
- Vaginal Devices (pessaries) can control incontinence and relieve prolapse for some women.
- Injection of materials around the urethra may strengthen resistance to urine flow and can be a good choice for some women.
- Surgery can restore support of the pelvic floor. New surgical methods can allow you to recover very quickly and return to normal activities in a few days.
To learn more about the Urogynecology Department at Harvard Vanguard, please click here.