What is Stress Incontinence?
Stress incontinence means you leak urine when you increase the pressure on the bladder, as in coughing, sneezing, walking, exercise or perhaps straining when lifting a heavy object. Any movement that suddenly increases the pressure on your bladder can cause uncontrollable loss of small amounts of urine even something as simple as changing position (e.g. standing up from a seated position).
How common is Stress Incontinence?
Stress incontinence is the most common type of incontinence. If you are experiencing stress incontinence then you are not alone, it is estimated that about three million women in the UK are regularly incontinent (this equates to approximately 4 in 100 adults) and over 50% of these experience stress incontinence.
Although stress incontinence becomes more common in older women with up to 20% of women over 40 having some degree of stress incontinence, It is also relatively prevalent in women between 18 and 40 years old as well and it is believed that the true number of people affected is much higher as many do not tell their doctor about their incontinence, due to embarrassment or a feeling that nothing can be done about it as incontinence is a normal part of ageing. This is a misconception as incidences can be successfully treated or significantly improved.
Stress incontinence can occur in men who have received treatment for prostrate cancer, especially those who have undergone radiotherapy or prostatectomy (removal of prostrate).
What Causes Stress Incontinence?
It happens when the pelvic floor muscles that support the bladder or urethral sphincter are weakened and therefore the pressure in the bladder becomes too great for the bladder outlet to withstand. The usual cause is weakened pelvic floor muscles and stress incontinence is often related to pregnancy, childbirth, obesity and increasing age (as muscles lose tension).
Your pelvic floor is made up of layers of muscles that form a sling passing from your coccyx (tip of your spine) to your pubic bone. It supports the bladder, bowel and uterus (womb), and forms the floor of the pelvis. Both men and women have a pelvic floor.
Going through the menopause can also increase incidence of Stress Incontinence in women as the reduced oestrogen levels in the body weaken both the pelvic floor and urethral sphincter. The urethra shortens and its lining becomes thinner and these reduce the urethral sphincter’s ability to close tightly.
Men can develop stress incontinence as a result of prostate surgery. The urethral sphincter is close to the top of the prostate and may be slightly injured when the prostate is removed.
Diagnosing Stress Incontinence
To diagnose stress incontinence, your health professional should ask about your symptoms and medical history. You may be asked to keep a ‘bladder diary’ for a week or so. This should record your fluid intake (what and how much you drink) and fluid output (the amount of urine you produce, and when you pass urine), whether you had an urge to urinate and the number of times you unintentionally pass urine.
Your health professional is likely to do a test on a sample of your urine to check that your incontinence isn’t being caused by a secondary cause such as an infection in your urinary tract and they may also do a blood test to check that your kidneys are working properly.
If they examine you they may carry out a check for loss of urine while you cough or strain. They may also carry out a rectal examination to see if you are constipated or whether the nerves to your bladder are damaged. A rectal examination is highly likely to be carried out for men as this will determine if the prostate is enlarged. For women, you may also be examined for weakness of the pelvic floor and signs of prolapse (when organs near your vagina, e.g. womb, bowel or bladder, slip from their expected position).
In some cases you may be referred to a Urologist who specialises in treating conditions of the urinary system). Alternatively, depending on the results of the examination, women may find themselves referred to a Gynaecologist (a specialist in women's reproductive health) or Urogynaecologist (a specialist in urinary and associated pelvic problems in women).
These specialists may carry out more detailed tests such as an Ultrasound (commonly used to check that your bladder is emptying properly), Cystoscopy (Looking inside the bladder and urinary system to identify abnormalities that may be causing the incontinence) or Urodynamic testing. Urodynamic testing measures the pressure in your bladder and the flow of urine. A catheter, is inserted into your bladder through your urethra and water is then passed through the catheter so the pressure on the bladder can be recorded.
How can I manage Stress Incontinence?
Stress Incontinence can be managed and improved though a variety of steps, some simpler than others.
It is likely that your health professional will recommend you to do pelvic floor muscle exercises (Kegel exercises). These exercises are designed to strengthen the pelvic floor muscles to help you control urinating.
Read more about Pelvic Floor Exercises.
For women, use of vaginal cones (weights that you hold in your vagina) may also be recommended to further strengthen the pelvic floor.
Being overweight or obese can increase likelihood of stress incontinence because there of the extra pressure on the pelvic floor. Therefore losing excess weight can help significantly. If exercising it's better to do low-impact exercises such as walking or swimming initially as high-impact exercise (eg running or jumping) can increase the pressure the bladder and leaks.
Make sure you drink enough fluids as cutting down the amount you drink makes your urine more concentrated and is likely to make stress incontinence worse. It is recommended to drink six to eight glasses of fluid regularly throughout the day, though be careful to avoid diuretics (such as coffee). Using the toilet frequently to avoid having a full bladder may also help.
Your doctor may also recommend some drug or surgical treatments although this isn't that common and some may have side effects to take into account.
If you're a woman and your stress incontinence is being caused by a lack of oestrogen then you may prescribed an oestrogen cream or oestrogen tablets to insert into your vagina. Your Doctor may also recommend you trying specific medication to help manage your incontinence.
More recently neuromuscular stimulation of the pelvic floor has been increasingly offered as an option. An electrical probe is placed into the vagina (for women) or rectum (for men) and a current passed through it which helps exercise and thus strengthen the pelvic floor muscles.
Also for women injections of bulk-forming agents, such as collagen, around the urethra can be effective. This helps keep your urethra closed and reduces urine leakage. The procedure is usually done by a urological specialist and takes around five minutes, although you will probably need to have repeat injections.
If you have severe stress incontinence and other treatments haven't been effective, your specialist might recommend that you have surgery to strengthen or tighten the tissues around your urethra. As with every procedure, there are some risks associated with having surgery for bladder problems and it is important you talk to your doctor and the surgeon about your surgical options and the risks that are associated with each one.
No matter what type of Incontinence you or the person you care for is experiencing it is important you discuss this with a Health Professional. Incontinence is often a symptom of an underlying condition and in many cases simple steps can help improve the condition.