Urinary stress incontinence
The most common form of urinary incontinence is stress incontinence and it occurs during activities which increase abdominal pressure, such as coughing, sneezing, laughing, lifting heavy objects or during physical activity. Increased abdominal pressure increases pressure in the bladder which in turn forces the urethra to open, resulting in the loss of urine.
Causes of stress incontinence
Stress incontinence most often results from weakened pelvic floor muscles which support the bladder and the urethral sphincter muscles. Causes include:
- Pregnancy and childbirth are the most common causes of weakened pelvic floor muscles.
- Pelvic floor muscles weakness can also be caused by the straining often associated with constipation or coughing.
- Therefore, smoking is associated with stress incontinence as smokers often suffer from chronic coughing.
- Excess weight is a contributing factor as the pelvic floor muscles are forced to carry a heavier load.
- It has also been found that some women have a genetic predisposition to pelvic floor weakness.
- At menopause the reduction in oestrogen levels can contribute to a loss of tone in the urethra, therefore, affecting its closing pressure. Reduced oestrogen levels also cause the pelvic floor muscles to become less elastic and, therefore, may aggravate existing muscle weakness.
Treatment of urinary stress incontinence
Pelvic floor exercises are designed to strengthen the pelvic floor muscles through actively tightening and lifting them at intervals. Strong, well activated pelvic floor muscles help support the bladder, uterus and bowel. The exercises are designed to work three different parts of the pelvic floor muscles: the muscles that control urine flow; the muscles that control the anal sphincter (muscles around the anus) and the muscles that surround the urethra and vagina. The pelvic floor muscles also interact with the deep abdominal muscles.
The exercises can be performed sitting, standing or lying down. A woman can do pelvic floor exercises while waiting in a queue or sitting at the office desk, without anyone noticing. The number of exercises required depends on the woman’s existing pelvic floor muscle strength but, generally, she will be required to do the exercises 5-6 times a day. It may take 2-3 months to notice a significant improvement. As with any exercise program, women should start gradually, building up the number of contractions and perform the exercises regularly. More important than having strong pelvic floor muscles, however, is the ability to activate them in time against increases in abdominal pressure (eg when sneezing, coughing or lifting).
is very helpful in teaching techniques to optimise your results. If not done properly, the exercises may exacerbate symptoms.
Pessaries may be an option for women who have incontinence as a result of genital prolapse, but for whom surgery or other treatments are unsuitable (e.g. elderly or unwell women). Pessaries are placed in the vagina, where they help re-position the bladder and urethra, limiting the leakage of urine. Pessaries provide a short-term solution but do not deal with the underlying cause of the incontinence.
Life style changes including exercise, healthy eating and weight loss can have positive effects on improving stress incontinence.
Surgical treatment of stress incontinence is becoming increasingly utilised due to its positive long term results. A vaginal sling procedure, tension-free vaginal tape (TVT),involves placing a thin mesh under the urethra like a hammock to support it. This procedure is very successful and the majority of people will experience cure of their urinary stress incontinence.