Stress Urinary Incontinence
Stress urinary incontinence is the involuntary loss of urine that occurs with activities, such as walking, running, sneezing, jumping, or laughing. Primarily experienced by women as they get older, it is seen in children and men. In children, little girls may have something called giggle incontinence, in which their underpants get wet when they giggle a lot. They grow out of it. In men, it may occur after prostate cancer surgery. Otherwise, it is not seen in men.
The anatomy of the female pelvis predisposes to stress incontinence. Women have short urethras with very little support under them. The weakening of the support under the urethra is what leads to leakage. Risk factors include anything that affects the pelvic floor muscles and ligaments, including pregnancy and childbirth, pelvic surgery, chronic constipation, and chronic coughing. Probably, the greatest risk factor is age. As we age, our pelvic muscles loose their elasticity and their ability to support the pelvic organs. Stress incontinence is often seen in conjunction with pelvic organ prolapse.
Stress incontinence is diagnosed by history and physical exam. If you tell your doctor that you leak with activity, then you have stress incontinence by definition. May practitioners will want to examine you with a full bladder and see the leakage when you a cough or jump in the office.
There are three treatment options: pelvic floor muscle exercises, bulking agents, or surgery. Pelvic floor muscle exercises are essentially kegel exercise. They should be done consistently three times per day. Physical therapists with a special interest in women’s health are available to instruct women on the most effective method of performing the exercises. Bulking agents can be injected around the urethra to try to tighten the urinary sphincter. The injection can be done in the office. Depending on the agent that is injected, it can last from 6 months to 2 years and reinjection can be done. Surgery in the mainstay of treatment. The most commonly performed surgery for stress incontinence is called a synthetic mid-urethral sling. It is done as an outpatient; it takes about 20 minutes to perform, and should last a lifetime. If you would like to learn more about stress urinary incontinence, please call our office or press the "Book Online" button to make an appointment to see one of our physicians.