Stress incontinence, also known as stress urinary incontinence (SUI) or ‘effort incontinence’ is a condition that causes the loss of small amounts of urine during coughing, sneezing, exercising, sudden movements, laughing, crying etc. This then refers to physical stress as in strain, on the pelvic floor muscles, as opposed to psychological stress (though psychological causes can also lead to incontinence). This of course is a highly unpleasant condition that can be highly embarrassing for sufferers not to mention of course highly impractical resulting in unwanted mess and smell and damage to the skin.
Fortunately there is light at the end of the tunnel and there are some treatments and management techniques that can help drastically to reduce and in some cases completely alleviate symptoms of SUI. Here we will look at how you can go about reducing SUI and the treatments available to you. First though we will look at the causes of stress incontinence so that you can better understand the problem.
The essential cause of stress incontinence is that the pelvic floor muscles are essentially too weak. Thus anything that causes abdominal pressure and thus bladder pressure will result in urination as the urethra (supported by the fascia of the pelvic floor) drops downwards due to lack of support.
The causes of the weakened muscle are various. It is more common in women than men and here it might be the result of pregnancy, childbirth, menopause or the menstrual cycle. This can be as a result of lower estrogen levels that results in lower muscular pressure. For most female athletes performing at a high level, some stress incontinence is unfortunately expected.
In men meanwhile stress incontinence is more likely to be a result of post-surgical complication and specifically after prostatectomy.
Management Techniques/Home Remedies
There are some things you can do yourself for stress incontinence that don’t require medication or surgery, but rather just require basic changes to your lifestyle. These include…
Drinking less water will mean you are less hydrated and storing less fluid in your bladder which in turn will of course make you less likely to suffer with stress incontinence. At the same time you need to be careful what you drink as some things are more likely to irritate the bladder. Steer clear of alcohol and carbonated beverage. At the same time be weary of what you eat – of course avoid diuretics such as mints that make you more likely to urinate, and also be sure to avoid spicy foods that can also irritate the bladder.
Smoking both irritates the bladder and causes coughing, and so quitting can be a good measure to take against stress incontinence.
Reducing BMI has been demonstrated in studies to help prevent incontinence. In one study weight loss was found to help reduce incontinence by an impressive 70%.
Exercising the pelvic floor muscles is one of the most commonly recommended forms of treatment for stress incontinence. Through this exercise it is possible to help strengthen the muscles and so provide more support to the urethra and sphincter muscles. Kegel exercises (named after their creator ‘Dr Arnold Kegel’) involve simply tensing and then releasing the pelvic floor muscles. Likewise the area can be exercised by holding urine in and the best way to do this is to begin urinating, then stop the urine mid-stream using the muscles, before moving to another urinal or toilet.
Various devices exist for strengthening such as the Progressive Resistance Vaginal Exerciser. This device also provides feedback allowing the practitioner to note whether their training is effective or not and whether or not they are using the correct technique. Meanwhile it is also possible to be referred to a specialist, as is the case with Supervised Pelvic Floor Muscle Training which involves one-on-one training and is used by the NHS in the UK. Vaginal cones can also be used to exercise the muscles more constantly, though they are less effective than other forms of exercise.
Biofeedback can be meanwhile used on its own in order to provide the sufferer with feedback regarding their muscles. This way they can become aware of when their muscles are relaxing, and what that sensation feels like. This in turn will help them to have more control over the area on a permanent basis rather than allowing it to relax which can result in the incontinence.
Electrical stimulation can be used (via the use of electrodes) to strengthen muscles around the pelvis in the same way as exercise by forcing muscle contractions and this can provide a suitable alternative for those who struggle with exercises.
Pessaries are ring shaped devices inserted into the vagina in order to treat vaginal prolapse. They have the effect of elevating the bladder neck and compressing the urethra which can help some women to overcome stress incontinence.
Failing these management techniques, of which exercise is the most effective, there are several medical options available for treating stress incontinence.
There are various forms of surgery available for stress incontinence. These include the use of what is known as a ‘sling’ which is a mesh made often from porcine or bovine biomaterials, or the patient’s own, which is designed in order to hold the urethra in a more upright position thereby supplanting the less effective pelvic floor muscles that aren’t providing the right support. Other surgical techniques include bladder repositioning which pulls the urethra up to a more normal position, or the Marshall Marchetti Krantz procedures (MMK) which is also known as bladder neck suspension surgery.
Peri/Trans Urethral Injections
These are injections of materials into the urethra that are intended to alter their texture and give them a more fixed position. These materials include blood and fat and have variable success. The most successful material is GAX collagen, which is successful in many cases, but which requires a ‘top up’ over time.
Artificial Urinary Sphincter
This involves the surgical insertion of an artificial sphincter circles the urethra which uses water pressure in order to close and release the urethra. This uses a valve that requires the user to press a button located under their skin when they need to urinate.
Alpha-1 adrenergic receptor mediates the contraction of the urinary bladder neck and so can be somewhat useful in treating stress incontinence.