What is stress incontinence?

Stress incontinence is the involuntary loss of urine due to a trigger or stressor. Essentially, urine loss occurs due to physical exertion or a rise in intra-abdominal pressure. This type of incontinence usually results in the loss of small amounts of urine (dribble), rather than large wetting accidents. Because stress incontinence is associated with a trigger, it is generally predictable. Initially, the loss of urine is controlled by using feminine pads. However, this is not a long-term solution.

Stress incontinence risk factors

This form of incontinence can result from physical stressors, life changes, behaviors, or other health conditions. Contributing factors can include:

• Weak pelvic floor muscles related to vaginal childbirth or menopause.
• Pelvic surgery (prostatectomy for men; hysterectomy for women).
• Obesity.
• Family history/race.
• Smoking and chronic cough.
• Occasional coughing.
• Sneezing.
• Exercise such as jogging, running or jumping.
• Laughing.
• Chronic constipation and straining.
• Heavy lifting.

Diagnosis

To assist in their diagnosis, a urologist will review the patient’s medical history, their family medical history, conduct a physical examination (including a urethral assessment), and review the patient’s symptoms. It is also standard to conduct a urinalysis to screen for a urinary infection. The physician may also ask the patient to complete a bladder (or voiding) diary, and Urodynamics testing.

Treatment options

The appropriate treatment option will be determined based on the underlying cause of urine leakage. Some treatments may be based on behavioral changes such as smoking cessation. Additional treatment options include:

• Vaginal estrogen cream can improve the integrity of the vaginal mucosa and underlying urethral tissue.
• Medications.
• Pessary (a device inserted into the vagina to support the bladder and urethra and prevent involuntary leakage).
• Surgical options such as bulking agents, or a midurethral sling.
• Pelvic floor muscle rehabilitation.
• Kegel exercises.
• Biofeedback.
• Surgical options.

Stress incontinence is the most common form of incontinence that is treated surgically. Surgical treatment is done to lift and support the connection between the bladder and the urethra. Surgery can be done through the vagina, through the abdomen, or a combination of the two. Surgical options include:

• Bladder suspensions or pulling the bladder up to a more normal position and securing it to muscle, ligament or bone.
• Sling procedures are often performed on patients with severe stress incontinence and intrinsic sphincter deficiencies. The goal is to create sufficient urethral compression to achieve bladder control.
• Artificial sphincters may help patients who are incontinent after surgery for prostate cancer or stress incontinence, trauma victims and patients with birth defects in the urinary tract.

If you are experiencing the loss of urinary control, contact Urology Austin to schedule an evaluation with one of our urologists.