【Main Points】
- Stress urinary incontinence is the unintentional leakage of urine occurs while the intra-abdominal pressure is increasing (e.g., coughing, sneezing, and exercise).
- Patients should practice Kegel exercises frequently to strengthen the contraction intensity of the pelvic floor muscle.
- Patients should avoid activities that increase abdominal pressure, such as lifting heavy objects or straining to defecate.
- Patients should avoid having diuretic drinks which includes caffeine or alcohol, such as coffee, tea, etc.
What is Stress Urinary Incontinence?
Stress urinary incontinence is the unintentional leakage of urine occurs while the intra-abdominal pressure is increasing (e.g., coughing, sneezing, and exercise). The main reason of urine leakage may be the weakness of the pelvic floor muscles and connective tissue, which makes bladder neck and urethral sphincter lack of support when intra-abdominal pressure increases. The other reason might be the weakness of urethral sphincter. The weakened muscle cause poor control of urethra and is not able to stop the flow of urine.
Stress urinary incontinence is the unintentional leakage of urine occurs while the intra-abdominal pressure is increasing (e.g., coughing, sneezing, and exercise). The main reason of urine leakage may be the weakness of the pelvic floor muscles and connective tissue, which makes bladder neck and urethral sphincter lack of support when intra-abdominal pressure increases. The other reason might be the weakness of urethral sphincter. The weakened muscle cause poor control of urethra and is not able to stop the flow of urine.
Symptoms:
Involuntary intermittent leakage of urine occurs when coughing, sneezing, exercising, lifting heavy objects, jumping, climbing stairs and laughing. When symptoms are severe, urine may leak even when walking, doing housework (e.g. washing dishes or sweeping the floor), or changing posture (e.g. from standing to squatting or sitting). If you experience these symptoms as described above, it may not be the stress urinary incontinence. Please make an appointment with doctors at the OB/GYN clinic to get further examination.
Involuntary intermittent leakage of urine occurs when coughing, sneezing, exercising, lifting heavy objects, jumping, climbing stairs and laughing. When symptoms are severe, urine may leak even when walking, doing housework (e.g. washing dishes or sweeping the floor), or changing posture (e.g. from standing to squatting or sitting). If you experience these symptoms as described above, it may not be the stress urinary incontinence. Please make an appointment with doctors at the OB/GYN clinic to get further examination.
What are the common treatment modalities?
- Conservative therapies:
- Kegel exercises: Active contraction for muscles around anus, vaginal, and urethra can further enhance the strength and tension of the entire pelvic floor muscles.
- In the beginning phase, patients must try to put a clean index finger or middle finger into the vaginal, and try to “stop urination.” If patients feel their fingers are clamped by the vaginal muscles, the right muscle groups are trained. The patients must remember the method and feeling of stopping urination.
- Patients are able to practice “stopping urination” or “hold the stool” at any time to contract the anus. However, it is not advisable to do this repeatedly during urination to avoid bladder damage.
- When patients start to take the exercise, they should gradually increase the time of training from 2-3 seconds in the beginning to 10 seconds. They should contract and relax the muscles for 20 consecutive times every time and practice the exercise at least 3 times per day for at least 2 months continuously to achieve the effect.
- Medication treatments: Medication such as estrogen may increases urethral sphincter resistance. Besides oral drugs, injection of Botox or Platelet-rich plasma (Platelet-rich plasma, PRP), which contains a large number of growth factors, may repair damaged pubo-urethral ligament and decrease the leakage of urine.
- Kegel exercises: Active contraction for muscles around anus, vaginal, and urethra can further enhance the strength and tension of the entire pelvic floor muscles.
- Electrical muscle stimulation: The use of electric current to stimulate the muscle contraction around the smooth muscles and the urethra through the vaginal, increasing the contractility of the urethra.
- Surgeries: The main purpose of the surgery is to keep bladder neck and urethra at their normal position by suspension, or to increase the close function of urethral sphincter. Common surgeries are Mid-urethral Intra-vaginal Sling and injection of collagen around the urethra.
Precautions for care:
- Develop the habit of keeping appropriate water intake and urine output: patients should take a small amount of drinking water for up to 2,000 cc per day. Also, patients should try to urinate every 2 to 3 hours. In order not to influence night sleep, patients should decrease water intake before going to bed.
- Patients should maintain a proper body weight since obesity may easily lead to weak abdominal muscles and increased abdominal pressure.
- Patients should avoid having diuretic drinks which includes caffeine or alcohol, such as coffee, tea, etc.
- On weekdays, patients should practice Kegel exercises more frequently to strengthen the pelvic floor and the contraction strength of the urethral muscle.
- Smoking cessation: Long-term smoking can cause coughing, which leads to excessive bladder pressure, and it may easily injure pelvic neuromuscular health.
- Patients should avoid activities that increase abdominal pressure, such as laughing, lifting heavy objects, climbing mountains, or straining to defecate. If it is unavoidable, patients should prepare pads in advance to maintain comfort.
References
- Capobianco, G., Madonia, M., Morelli, S., Dessole, F., De Vita, D., Cherchi, P. L., &Dessole, S. (2018). Management of female stress urinary incontinence: a care pathway and update. Maturitas, 109, 32-38. https://doi.org/10.1016/j.maturitas.2017.12.008
- Chao, W.T., Horng, H.C. (2022). Development and latest treatment of midurethral suspension surgery for stress urinary leakage. Clinical Medicine Journal, 90(3), 586-588. https://doi.org/10.6666/ClinMed.202209_90(3).0092
- Falah-Hassani, K., Reeves, J., Hickling, D., & McLean, L. (2021). The pathophysiology of stress urinary incontience : a systematic review and metanalysis. International Urogynecology Journal, 32(3), 501-552. https://doi.org/10.1007/s00192-020-04622-9
- Wang, X., Xu, X., Luo, J., Chen, Z., & Feng, S. (2020). Effect of app-based audio guidance pelvic floor muscle training on treatment of stress urinary incontinence in primiparas: A randomized controlled trial. International Journal of Nursing Studies, 104, 103527. https://doi.org/10.1016/j.ijnurstu.2020.103527
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