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What is Stress Incontinence?

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Urinary incontinence is any loss of control of your bladder. Any amount of urine that leaks out when you don’t want it is called urinary incontinence. There are several types of urinary incontinence, and one of the most common is stress incontinence.

In stress incontinence, the “stress” refers to an increase in abdominal pressure when coughing, laughing, sneezing, exercising or even just bending over. These activities increase the pressure in the bladder and can force urine out, if the muscles that keep urine in the bladder are not working appropriately. While most people associate this kind of incontinence with exercising, coughing or laughing, it is helpful to note that anything that increases abdominal pressure can cause stress incontinence. Lifting a child, reaching over to pick up something, getting up out of a chair - all these activities increase abdominal pressure and can lead to stress incontinence. It can help to think (or even write down) what you are doing when incontinence occurs. This can help to identify whether you leak with stress, urgency or both.

What causes stress incontinence?

Like many diseases, it is often difficult to assign just one cause for stress incontinence in any person. Research has suggested that, in women, several factors such as advanced age, pregnancy/childbirth, obesity, smoking or genetics can all contribute to your risk of stress incontinence. Some of these factors, such as smoking or obesity can be reversed (although, it can be very difficult to quit smoking or lose weight). Other factors such as age and genetics, we can do nothing about. Stress incontinence in men is most often the result of prostate surgery or radiation therapy to treat prostate cancer.

What are treatment options for stress incontinence?

Treatment for stress incontinence often begins with pelvic floor exercises (commonly referred to as Kegel exercises). These exercises help to strengthen the muscles that are responsible for keeping the urine inside of you as the pressure in your bladder rises (such as from sneezing). Many people find that pelvic floor exercises can be even more effective if guided by a specialist called a pelvic floor physical therapist. Others may be able to perform the exercises well on their own with some education. It can take several weeks for daily exercise to see results so be patient with yourself. It is important to remember that pelvic floor exercises should be continued on a regular basis to maintain the benefits.

Another non-surgical treatment for stress incontinence is incontinence pessaries. These are small devices that are placed within the vaginal canal and compress the urethra. The compression helps to prevent urine loss with increases in abdominal pressure. Incontinence pessaries can be fitted in a doctor’s office, but more recently over-the-counter incontinence pessaries have become available. Pessaries do have to be removed frequently and can cause discomfort in some women. However, they have low risk for harm and can provide improvement in stress incontinence in appropriate patients.

What surgical therapies are available for stress incontinence?

Unfortunately, some people either do not see satisfactory improvement or do not tolerate more conservative therapies like pelvic floor exercises. Surgical therapy for SUI may be appropriate in these cases. There are several types of surgical therapy for stress incontinence but the most common of these are synthetic slings. Slings help to support the urine urethra and help to improve incontinence. There many options for the type of sling to choose from, though most have similar effectiveness and safety. Even though slings are generally safe, there are some risks for any surgical incontinence surgery, and these should be considered. You should try to balance how much improvement you can expect from a sling against any risks that are involved.

From pelvic floor exercises that you can do on your own to surgical therapies performed by a doctor, there are many options for treatment of stress incontinence. If you are bothered by your symptoms, there is a lot that you can do and many resources to help you to be successful.

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