Care of Patient with Stress Urinary Incontinence

What is Stress Urinary Incontinence?

Stress urinary incontinence is the unintentional loss of urine.It happens when the intra-abdominal pressure increases (e.g. coughing, sneezing, heavy loads), a small amount of urine will be involuntarily discharged.

Cause:
Stress urinary incontinence is due to the pelvic floor muscle weakness. The causes are including menopause, multiple births, aging, surgery, obesity, pregnancy, congenital urethral sphincter weakness and radiotherapy, etc.

Clinical symptom classification:

Level 1 (Mild): urine is occasionally discharged when patients have a severe cough, sneeze, move heavy objective, lift heavy objects, jump, or laugh.
Level 2 (Moderate): urine is often discharged when patients have a mild cough, laugh, run or trot, climb stairs, or mop the floor.
Level 3 (Severe): urine is discharged when patients walk, do housework (e.g. washing dishes or sweeping the floor), or change posture (e.g. from standing to squatting or sitting).
Level 4 (Extremely Severe): urine is discharged at a resting state, such as turning over on the bed.

Treatments:

Conservative therapies:
1. Medication treatments: Patients with stress urinary incontinence tend to be fragile and weaker, medication for increasing urethral sphincter resistance can be utilized.
2. Kegel exercises: Active contraction for muscles around anus, vagina, and urethra can further enhance the strength and tension of the entire pelvic floor muscles.
3. In order to train pelvic muscles correctly, in the beginning phase, patients must try to put a clean index finger or middle finger into the vagina, 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 way and feeling of stopping urination.
4. Patients are able to practice “to stop urination” or “hold the stool” at any time to contract the anus. However, they should not repeatedly do so during urination to prevent bladder injury.
5. When patients start to take the exercise, they should gradually increase the length of 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 everyday for at least 2 months continuously to achieve the effect.
Electrical muscle stimulation:
The use of current to stimulate the muscle contraction around the smooth muscles and the urethra through the vagina, increasing the contractile force of the urethra.
Surgeries: Patients may consider undergoing a surgery if their symptoms of incontinence persist after they receive conservative therapies. The surgeries are effective, and the incontinence symptoms of 48%-90% of women will be improved. The common surgeries are as follows:
1. Anterior-Posterior Vaginal Repair.
2. Midurethral Intra-vaginal Sling.

Precautions for care:

For water intake management, patients should take a small amount of drinking water for up to 2,000 cc per day. If the water intake is too little, the number of urinary irritants will be increased to increase the frequency of urinary incontinence.
Patients should try to finish drinking the recommended amount of water before 6 pm to reduce the frequency of urination at night.
Patients should maintain a proper body weight since obesity may easily lead to weak abdominal muscles and increased abdominal pressure.
Patients should avoid taking irritating foods, such as coffee, tea, alcohol, soda and cola, etc.
On weekdays, patients should practice Kegel exercises more frequently to strengthen the pelvic floor and the contraction strength of the urethral muscle.
Patients should try to urinate every 2 to 3 hours. It is not abnormal to get up to urinate once in the bathroom after going to sleep at night.
Smoking cessation: Long-term smoking can cause coughing and excessive bladder pressure, which may easily injure pelvic neuromuscular health.
Patients should avoid activities that increase abdominal pressure, such as laughing, lifting heavy objects, climbing mountains, or forced defecation. If it is unavoidable, patients should prepare pads in advance to maintain comfort.

References

Falah-Hassani, K., Reeves, J., Shiri, R., Hickling, D., & McLean, L. (2021). The pathophysiology of stress urinary incontinence: a systematic review and meta- analysis. International Urogynecology Journal, 1-52. https://doi.org/10.1007/s00192-020-04622-9
Hsiao, S. M. (2017). Update of the Conservative Treatment for Female Stress Urinary Incontinence. Formosan Journal of Medicine, 21(5), 481-484.
Long, C. Y. (2017). Update of Surgery for Female Stress Urinary Incontinence. Formosan Journal of Medicine, 21(5), 486-491.
Lukacz, J. L., Santiago-Lastra, Y., Albo, M. E., & Brubaker, L. (2017). Urinary incontinence in women: A review. Journal of the Americal Medical Association, 318(16), 1592-1604. https://doi.org/10.1001/jama.2017.12137
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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