Introduction
Stress urinary incontinence, also known as SUI, is a type of bladder control problems that affect many people. It is a condition in which urine leaks out when the pelvic floor muscles are put under stress, such as during physical activities, coughing, or laughing.
Here, we will discuss the causes, symptoms, and treatments of SUI.
Definition of Stress Urinary Incontinence
Stress urinary incontinence (SUI) is the involuntary leakage of urine due to increased abdominal pressure associated with exertion, coughing, or sneezing. It is one of the most common types of urinary incontinence experienced by women. While SUI can be caused by a variety of reasons, including obesity, menopause, and medical conditions such as multiple sclerosis or diabetes; it is most commonly related to weakened muscles in the pelvic floor.
The risk of developing SUI increases with age and certain physical characteristics – including having previously given birth vaginally or being overweight. Other factors that may increase one’s risk include bladder outlet obstruction, excessive fluid intake and tobacco use. The exact cause is often difficult to determine as symptoms may vary among individuals.
Regarding treatment options for SUI, lifestyle changes such as improved diet and exercise can improve symptoms without medications or invasive measures such as surgery. Additionally, there are several therapeutic techniques that have proven successful for improving muscle strength; including:
- Pelvic floor muscle training (PFMT)
- Biofeedback therapy
- Electrical stimulation
- Manual therapy
Generally, a combination of treatments work best for optimizing success in treating SUI symptoms.
Types of Stress Urinary Incontinence
Stress urinary incontinence (SUI) is a type of incontinence that happens when physical movement or activity such as coughing, sneezing, laughing or running causes an unexpected leakage of urine. It can be caused by damage to the muscles, ligaments and other supporting structures of the pelvic floor.
There are three main types of stress urinary incontinence:
- Simple stress urinary incontinence occurs when the bladder is overactive or if there is damage to the muscles, ligaments, connective tissue, or other supportive structures that keep the urethra closed. Simple stress urinary incontinence does not involve nerve damage or neurological disorder.
- Urge urinary incontinence occurs when there is an uncontrolled contraction of bladder muscles as a result of nerve damage causing you to leak urine with no warning. Urge incontinence can be caused by neurological diseases such as Parkinson’s Disease and Multiple Sclerosis.
- Mixed urge and stress urinary incontinence refers to cases in which both urge and simple stress components are found in a person’s condition at the same time. It usually results from overactive bladder (OAB) symptoms combined with weak pelvic floor muscles which can occur after pregnancy, childbirth or surgery where nerves are damaged along with those muscles responsible for holding in urine unintentionally.
Regardless of which type someone has been diagnosed with, there are treatments available ranging from lifestyle modifications to surgical options that aim to reduce or eliminate SUI symptoms and improve quality of life for individuals dealing with this condition every day.
Causes
Stress urinary incontinence is a type of urinary incontinence caused by physical exertion during activities such as coughing, sneezing, lifting, and running. This type of incontinence occurs due to weakened pelvic floor muscles, weakened sphincter muscles, childbirth, obesity, and menopause. Other potential causes include surgery, smoking, radiation therapy, neurological conditions, and certain medications.
Let’s explore some of these causes in more detail:
- Weakened pelvic floor muscles.
- Weakened sphincter muscles.
- Childbirth.
- Obesity.
- Menopause.
- Surgery.
- Smoking.
- Radiation therapy.
- Neurological conditions.
- Certain medications.
Pregnancy and Childbirth
Pregnancy and childbirth are common causes of stress urinary incontinence (SUI). During pregnancy, the body produces hormones that relax the muscle fibers of the pelvic floor, resulting in physical stress on the urethral sphincter. This increase in abdominal pressure can cause some leakage.
Childbirth can also result in SUI due to changes in the structure of the bladder or urethra or due aging muscles which become weakened after childbirth and is more likely seen in women who have delivered multiple children. Forceps delivery and large babies, compared to those born vaginally, cause further physical trauma which might lead to SUI.
Aging
Age is often considered to be an important risk factor for developing stress urinary incontinence (SUI). As individuals age, the pelvic floor muscles weaken and thin due to a decrease in the production of estrogen and other factors. This weakening of the pelvic floor muscles can cause them to become more lax and unable to properly support the bladder, resulting in SUI.
Other age-related factors may include:
- Changes in hormone levels, which can also lead to weakened muscles and less nerve control over the sphincter muscle surrounding the urethra
- Changes in bladder elasticity, making it less able to contain urine
- Weakening of the pelvic ligaments which support the urethra
- Changes in the soft tissues that make up and surround the bladder
- Development of medical conditions or physical ailments that affect muscle tone
All of these aging changes can work together to increase SUI symptoms.
Weak Pelvic Floor Muscles
Stress urinary incontinence is a type of urinary incontinence caused by weakened pelvic floor muscles. These muscles are the foundation of our core and help to support the entire body. The job of the pelvic floor muscles is to support the uterus, bladder, and rectum and control the opening and closing of urethral sphincter. When these muscles become weak due to aging, childbirth, or injury due to an accident, these organs may slip slightly downward causing slight leakage of urine when sneezing, coughing or laughing. It is important to note that although this condition sometimes occurs in men it is more common among women.
The good news is that stress urinary incontinence can usually be treated with:
- Exercises designed to strengthen the pelvic floor muscles.
- Medications if needed.
If you suffer from leaking urine when you cough or sneeze then you should speak with your healthcare provider right away as it may be a sign of stress urinary incontinence and there are things you can do help manage or even cure this condition!
Symptoms
Stress urinary incontinence (SUI) is a type of urinary incontinence and is characterized by involuntary leakage of urine during physical activities such as coughing, sneezing or exercising. Symptoms often include:
- an urgent need to urinate or a sudden, involuntary leak of urine.
- a feeling of discomfort in the abdomen or lower back.
- loss of bladder control.
- frequent urination.
- a feeling of incomplete bladder emptying.
Leakage of Urine
Leakage of urine is the most common symptom of stress urinary incontinence (SUI). It is defined as the inadvertent loss of urine associated with physical activities such as coughing, sneezing, jumping or laughing. The amount of urine leakage can vary from a few drops to large amounts and can be experienced episodically or on a continuous basis. If a person reports an increase in frequency or amount of leakage over time, it may indicate worsening SUI.
Other symptoms are listed below:
- Straining or pushing down to pass bladder emptying and produce stream
- Sudden urge to go to the bathroom
- Going to the bathroom frequently (more than 7 times a day)
- Getting up more than once at night to urinate
- Feeling that the bladder has not been completely emptied after voiding
- Pain during urination
Urge to Urinate
Stress urinary incontinence (SUI) is the inability to control urination during physical activity like sneezing, coughing or laughing. Urge urinary incontinence is the sudden, overwhelming urge to urinate that can be so intense that you may not make it to the bathroom in time.
The feeling of urgency can often come on even if your bladder is only partially full.
When it comes to urge urinary incontinence, you may find yourself:
- needing to use the restroom frequently
- having accidents while out and about
- experiencing a sudden need to go and having a hard time controlling your urine long enough to get to a bathroom
- needing to wake up multiple times throughout the night due to an urge or accident
- waking in wet clothing after having an accident during sleep
- having difficulty holding your urine for any length of time because of a strong urge.
Pain During Urination
Pain during urination – also referred to as dysuria – is a common symptom of stress urinary incontinence (SUI). Pain is typically due to urethral inflammation caused by SUI-associated physical exertion, leading to soreness and burning in the area. This painful symptom may be accompanied by a frequent need to urinate, especially if there is leakage of urine when the individual coughs or laughs.
Addressing this symptom typically involves attempts to manage the underlying causes of SUI, such as:
- Pelvic floor exercises
- Lifestyle changes (reducing caffeine intake or avoiding certain foods and activities that worsen symptoms)
- Medications
- Medical devices designed to improve bladder control
If these measures do not produce results or if pain becomes severe, it may be necessary for an individual to consult a doctor who specializes in urinary incontinence.
Diagnosis
Stress urinary incontinence is typically diagnosed by taking a thorough medical history, performing a physical exam and tests. A doctor may ask questions related to the individual’s lifestyle and health habits, such as how often they urinate, and if they experience leakage when they cough, laugh, or exercise.
Diagnostic tests may include a urinalysis, bladder imaging, or stress testing.
Physical Exam
A physical exam can be an important part of diagnosing a medical condition. A thorough physical examination typically consists of questions about a patient’s health history as well as an assessment of vital signs, posture, and range of motion. Your doctor may also check for abnormalities in areas such as the head and neck, chest or abdomen and examine extremities to assess muscle strength and bone density. Depending on your symptoms, they may want to perform additional exams such as blood tests or imaging scans.
Your doctor will likely ask you questions about current symptoms, as well as past medical conditions and family history. They’ll check your blood pressure, pulse rate, respiration rate and temperature to assess overall health. They may also listen to the heart for murmurs or other irregular sounds that could signal a potential cardiac issue. Further testing might include tests for reflexes or joint mobility if indicated by your symptoms.
Depending on what is being examined or evaluated, you might undergo other specialized exams during a physical exam. These can range from eye exams to test vision impairment to neurological tests that assess mental functions like memory or motor skills.
Urine Tests
As part of the diagnosis process, your doctor may want to conduct some urine tests. These include a urine culture to look for the presence of a urinary tract infection, as well as blood and protein levels to determine if there is any kidney damage. If you are still experiencing symptoms after treatment, they may suggest a more specialized test such as a cystometrogram or urodynamic studies which can help provide a more precise diagnosis.
The results of certain urine tests can be used in combination with other clinical assessments to determine the most appropriate intervention for stress incontinence. This includes looking at:
- Lifestyle and behavioral factors that could be affecting urinary control such as fluid intake and caffeine consumption.
- Medications associated with stress incontinence.
- Assessing other physical factors like pelvic anatomy and mobility that might contribute to bladder leakage.
Imaging Tests
Imaging tests can help diagnose a wide range of medical conditions, as they can provide detailed images and information about structures within the body. Imaging tests are helpful in diagnosing problems with organs, tissues, and bones. While X-rays are the most common type of imaging test, there are several other types of imaging tests used in diagnosis.
- X-Rays: X-rays use radiation to create images of your bones, blood vessels, and soft tissues on film or a digital display. They are primarily used to diagnose broken bones and dense tissues such as cartilage or bone spurs.
- Ultrasound: Ultrasound uses soundwave technology to create images of muscular tissue, blood vessels, and even unborn fetuses. This type of imaging test is commonly used for pregnant women or in abdominal scans to identify tumors or abnormalities of internal organs.
- Magnetic Resonance Imaging (MRI): MRIs use a powerful magnetic field along with radio waves to create detailed images of soft tissues such as muscles and glands that cannot be seen in an X-ray. MRIs are used to diagnose sports injuries, diseases related to the central nervous system, and cancers inside the body.
- Computer Tomography (CT) Scan: CT scans create a cross-sectional image using X-ray technology that is then reconstructed on computer software so doctors can analyze it more clearly than an X-ray alone could provide. Physician may use CT scans when diagnosing broken bones or organ damage from trauma or injury.
- Nuclear Medicine: Special sensors detect radiation emitted by radioactive materials injected into the body where they accumulate in certain organs and cells which then show up brightly on the image scan providing details about organ structure, age, inflammation, size comparison, tissue type, malfunctions, etc.
Treatment
Treatment for stress urinary incontinence is typically focused on improving muscle strength in the pelvic floor muscles. This can be achieved through physical therapy and exercises, as well as lifestyle modifications. Additionally, there are certain medications and surgeries that can be used to treat stress urinary incontinence. Let’s discuss these treatment options in more detail.
Pelvic Floor Exercises
Pelvic floor exercises, also known as Kegel exercises, are an effective way of strengthening the muscles that support the bladder, uterus and bowel. A combination of strengthening, relaxation and awareness activities can assist in regaining some control over the leakage of urine.
Simply squeezing the pelvic floor muscles for six to ten seconds and then releasing them ten to twenty times each day can be a great way to start. Ensure each contraction is deep – focus on tightening your pelvic floor muscles like you are trying to stop yourself from passing wind. Relax for three seconds between each contraction. As you do this more frequently, start increasing your times until you reach a goal hold time of around 6 – 10 seconds. You can also perform quick pelvic floor contractions if you are feeling unbalanced or if there is a chance of leakage when sneezing or coughing – such as holding your breath during laughter or physical activity.
It is important to note that improving your core strength and posture can also help to improve your incontinence symptoms, however these practices should never replace exercises that directly involve the pelvic floor muscles (such as Pilates). Strengthening activities such as walking and stair climbing may be beneficial if it does not cause leakage during exercise or afterwards when coughing or sneezing. If any activity does cause severe leaking then it is best to either try a lesser intensity form of exercise (ie walking instead of jogging), use additional protection such as pads or seek professional advice from a continence physiotherapist who will be able to provide tailored exercises specific to your individual condition.
Medication
Medication is one of the options available to manage stress urinary incontinence (SUI) in both men and women. Medication can be used alone or in combination with other treatments, such as physical therapy, surgery and lifestyle changes.
The most common drug used to treat SUI is duloxetine (Cymbalta), a serotonin-norepinephrine reuptake inhibitor. Duloxetine works by increasing urethral closure pressure and improving the integrity of the lower urinary tract muscles. This can help reduce symptoms of SUI such as reduced urine leakage when coughing or sneezing. It is usually taken once a day, either with or without food. Possible side effects include nausea, dizziness, dry mouth and increased sweating.
Alpha-blockers may also be prescribed for men with SUI caused by prostatic enlargement, since these medications are known to reduce urethral resistance and improve urine flow. Common alpha-blockers include doxazosin (Cardura) and terazosin (Hytrin). Alpha-blockers should not be used if you have severe anemia or orthostatic hypotension (dizziness that happens when you stand up quickly).
Finally, anticholinergic drugs may also be prescribed to relax bladder muscle contractions that cause urinary urge incontinence or overactive bladder syndrome. Common anticholinergics include oxybutynin (Ditrem), trospium chloride (Sanctura) and fesoterodine (Toviaz). These drugs take 7–21 days to take full effect and can cause dry mouth or constipation in some patients.
Surgery
Surgery is one treatment option for stress urinary incontinence. Depending on the severity of symptoms, surgery can improve or resolve urinary leakage.
The two common types of surgical treatments are urethral sling procedures and bladder suspension procedures. The choice of operation will depend on the underlying cause of your incontinence, and your surgeon will discuss with you which one is most suitable to try to get a benefit from both procedures if possible.
Urethral slings are designed to support the urethra and reduce urine leakage during activities that put pressure on your lower abdomen. A sling is created by placing small strips or pieces of material that act like a hammock beneath the urethra.
In bladder suspension surgeries, stitches or special meshes are used to place the bladder in its anatomical position within the pelvis so that it no longer droops down with activities that involve straining and external pressure such as coughing, sneezing and laughing. All surgical treatments for SUI involve some amount of risk, including potential retention (inability to empty your bladder) after surgery, infection and overactive bladder symptoms due to excessive tissue removal.
Recovery time varies according to type of procedure performed but may take several weeks before full activity levels are reached again post surgery.
