Stress Incontinence

Involuntary loss of urine during exertion, coughing, or sneezing

  • More common with increasing age
  • Almost exclusively affects females
  • Genetics and lifestyle are not significant factors

Stress incontinence results from weakness of the urethra (the tube from the bladder to the outside of the body) and pelvic floor muscles. These muscles support the bladder and help to control the opening and closing of the bladder outlet when passing urine. Weakness of the muscles allows the bladder neck to drop. Involuntary loss of urine occurs when pressure in the abdomen is increased.

In mild stress incontinence, a small amount of urine leaks out of the bladder during strenuous activities, such as running. In severe cases, urine escapes during activities that cause increased pressure on the bladder, such as coughing or lifting. Stress incontinence is the most common type of incontinence and mostly affects women.

The disorder commonly occurs during and after pregnancy; after surgery in the pelvic area; during the menopause, when a reduced level of the hormone oestrogen causes the pelvic muscles to lose elasticity; and with increasing age. Stress incontinence may also be linked to a prolapse of the uterus and vagina, rectal prolapse, or a prolapsed bladder. The condition is more likely to develop if you have a persistent cough. Rarely, men develop stress incontinence after prostate surgery.

Cause of stress incontinence

In stress incontinence, the muscles in the pelvic floor cannot support the bladder. The bladder neck drops, and the sphincter muscles become unable to keep it closed.

How is it diagnosed?

Your doctor may diagnose stress incontinence after asking about your fluid intake, how often you pass urine, the amount of urine you pass, and when you leak urine. He or she will perform a pelvic examination to check your pelvic floor muscles and find out if you have a prolapsed uterus. The doctor may refer you to hospital for urodynamic studies to assess your bladder function.

What is the treatment?

Your doctor will probably recommend pelvic floor exercises to strengthen the pelvic floor muscles, which are often effective in treating stress incontinence, whatever the cause. If the condition occurs after childbirth, muscle tone will gradually return but the exercises may speed recovery. In addition to pelvic floor exercises, you may be advised also to try other ways of exercising the pelvic muscles, such as electrical stimulation or vaginal cones. Electrical stimulation involves using a special electrical device to contract the pelvic floor muscles. A vaginal cone is a small plastic cone that you put inside the vagina for about 15 minutes twice a day. You need to use the pelvic floor muscles to keep the cone in. The cones come in different weights; you start with the lightest and, when you can hold it in comfortably, progress to a heavier weight, and so on. If you are overweight, your doctor may recommend a diet to help you lose weight (see Controlling your weight).

If these measures alone do not help, your doctor may prescribe a drug called duloxetine to be used in addition to pelvic floor exercises. If neither exercises nor drug treatment is effective, your doctor may suggest surgery to support your bladder or lift it back into the correct position, which is often successful in restoring normal or near-normal bladder control.

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

The subjects, conditions and treatments covered in this encyclopaedia are for information only and may not be covered by your insurance product should you make a claim.

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