Overview
Stress incontinence is a type of urinary incontinence where there is an unintentional loss of urine during physical movement or activity, such as coughing, laughing, sneezing, running, or heavy lifting. The bladder is put under pressure, causing urine leakage. It is not related to psychological stress and is more common in women than men. Common risk factors include previous pelvic surgery, being overweight or obese, and high-impact activities over many years.
Understanding the disease
Symptoms
Symptoms of stress incontinence include the unintentional loss of urine during physical movement or activity, such as coughing, laughing, sneezing, running, or heavy lifting. This condition is not related to psychological stress. It primarily affects women more than men, and can lead to embarrassment, social isolation, and limitations in daily activities. Other potential complications may include emotional distress, mixed urinary incontinence (a combination of stress and urgency incontinence), and prostate surgery complications in men.
Risk Factors
The risk factors for developing stress incontinence include age, as physical changes can weaken muscles; previous pelvic surgery, such as hysterectomy in women and surgery for prostate cancer in men; being overweight or obese; and engaging in high-impact activities over many years. Other factors that may worsen stress incontinence include illnesses causing chronic coughing, smoking, and obesity.
Development
Stress incontinence is caused by physical movement or activity that puts pressure on the bladder, leading to the unintentional leakage of urine. The primary risk factors for stress incontinence include:
- Age: Physical changes that occur as a person ages, such as the weakening of muscles, may increase the risk of developing stress incontinence.
- Type of childbirth delivery: Women who have had a vaginal delivery, especially those who have had forceps or vacuum-assisted deliveries, are more likely to develop stress incontinence compared to those who have had a cesarean section.
- Body weight: People who are overweight or obese are at a higher risk of stress incontinence due to the increased pressure on the abdominal and pelvic organs.
- Previous pelvic surgery: Hysterectomy in women and surgery for prostate cancer in men can weaken the muscles that support the bladder and urethra, increasing the risk of stress incontinence. Stress incontinence is not related to psychological stress, and it can occur at any age, although it is more common in women than in men. Other factors that may worsen stress incontinence include illnesses that cause chronic coughing, obesity, smoking, and high-impact activities over many years.
Assessment and Diagnosis
Triage
You should consider seeing a doctor if stress incontinence is affecting your daily life and you're experiencing embarrassment, distress, or discomfort due to the condition. If conservative measures, such as pelvic floor exercises, lifestyle changes, and bladder training, do not provide relief, consulting a healthcare professional would be appropriate. Additionally, if you have other concerning symptoms or if your stress incontinence is caused by certain factors, such as previous pelvic surgery or prostate surgery, seeking medical advice is recommended.
Diagnosis
To diagnose stress incontinence, a healthcare provider will typically start with a medical history, physical exam, and urine test. They may also perform a urinary stress test and urodynamic tests to assess bladder function. If necessary, they may refer you to a specialist like a urologist or urogynecologist for further evaluation. Preparing in advance by filling out questionnaires and keeping a bladder diary can help your provider understand your symptoms and identify contributing factors.
Management and Treatment
Complications
Potential complications of stress incontinence may include emotional distress, disrupted daily activities, and mixed urinary incontinence (a combination of stress incontinence and urgency incontinence). Emotional distress may arise from embarrassment and discomfort associated with the condition, affecting work, social life, relationships, and even sexual activities. People may feel embarrassed about needing pads or incontinence garments. Mixed urinary incontinence is a common complication, where individuals experience both stress incontinence and urgency incontinence, resulting from bladder muscle contractions that cause an urgent need to urinate.
Home Remedies
Home remedies for stress incontinence may include:
- Pelvic floor exercises: Regularly performing pelvic floor exercises can help strengthen the muscles that support the bladder and urethra, reducing the risk of stress incontinence.
- Bladder training: Gradually increasing the time between trips to the bathroom can help your bladder hold more urine, reducing the occurrence of leakage.
- Avoiding bladder irritants: Limiting the consumption of caffeine, alcohol, and acidic foods can help reduce bladder irritation and prevent incontinence.
- Maintaining a healthy weight: Losing excess weight can help reduce pressure on the bladder and pelvic muscles, reducing the risk of incontinence.
- Eating fiber-rich foods: Consuming more fiber can help prevent constipation, which may contribute to urinary incontinence.
- Quitting smoking: Smoking can lead to chronic coughing, which may worsen stress incontinence. Quitting smoking can help alleviate this contributing factor. Remember, it's essential to consult with a healthcare professional for personalized advice and treatment options.
Treatment
There are various treatments for stress incontinence, depending on the severity of the condition and the underlying causes. Some common treatments include:
- Kegel Exercises: Pelvic floor exercises, such as Kegel exercises, can help strengthen the muscles supporting the bladder and urethra, reducing stress incontinence. These exercises can be done at home and involve contracting and relaxing the pelvic floor muscles.
- Bladder Training: This involves gradually increasing the time between urination and learning to resist the urge to urinate. This can help the bladder muscles regain control and reduce incontinence episodes.
- Lifestyle Changes: Maintaining a healthy weight, avoiding smoking, and limiting caffeine and alcohol intake can reduce the risk of stress incontinence. In addition, avoiding high-impact activities and lifting heavy objects can help prevent worsening of the condition.
- Medications: Certain medications, such as anticholinergics and beta-3 agonists, can help relax the bladder muscles, reducing the frequency of incontinence episodes.
- Pelvic Floor Physical Therapy: A physical therapist can provide targeted exercises and treatments to improve pelvic floor muscle function and strength, reducing incontinence symptoms.
- Surgery: In some cases, surgical options might be considered, such as pelvic floor repair, sling procedures, or bladder neck suspension. These procedures can help restore the normal function of the urinary system and improve incontinence symptoms.
- Incontinence Products: Abdominal slings, pads, and catheters can help manage stress incontinence and provide protection during episodes. It's essential to consult with a healthcare professional to determine the most appropriate treatment for your specific case.
Preparing for medical consultation
To prepare for an appointment for stress incontinence, you should:
- Gather information: Make a list of your symptoms, including when urine leakage occurs.
- List medications: Create a list of any medications, herbs, or vitamin supplements you are taking, including doses and how often you take them.
- Bring a support person: Have a family member or close friend accompany you to the appointment to help you remember the information provided.
- Prepare questions: Compile a list of questions to ask your healthcare provider, prioritizing the most important ones. Some questions to consider asking include:
- Will my stress incontinence get worse?
- Could pelvic floor exercises help me? How do I perform them?
- How does my weight affect my condition?
- Could my medications be aggravating my stress incontinence?
- What tests might I need to determine the cause of my incontinence? By preparing in advance, you can make the most of your appointment and ensure that all your concerns are addressed.