What is Stress Urinary Incontinence? 
Stress urinary incontinence is caused by the weakness of the abdominal and perineal muscles. When intra-abdominal pressure increases (e.g. coughing, sneezing, heavy loads), a small amount of urine will be involuntarily discharged.

Cause: 
Stress urinary incontinence is caused by the weakness of support structure of pelvic floor muscle groups. The causes include menopause, multiple births, aging, surgery and obesity, pregnancy, congenital urethral sphincter weakness, radiotherapy, etc.

Levels: 
  1. Level 1 (Mild): urine is occasionally discharged when patients have a severe cough, sneeze, move heavy objective, lift heavy objects, jump, or laugh.
  2. Level 2 (Moderate): urine is often discharged when patients have a mild cough, laugh, run or trot, climb stairs, or mop the floor.
  3. 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).
  4. Level 4 (Extremely Severe): urine is discharged at a resting state, such as turning over on the bed.
 
Treatments:
  1. Conservative therapies: 
    1. Medication treatments: the urethral tissues of patients with stress urinary incontinence tend to be fragile and weaker, medication for increasing urethral sphincter resistance can be utilized.
    2. Kegel exercises: The use of 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 from 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.
  2. 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.
  3. 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.
 
Precautions for self-care: 
  1. For water intake management, patients should take a small amount of drinking water (i.e. 120-150 cc/hour) 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.
  2. Patients should try to finish drinking the recommended amount of water before 6 pm to reduce the frequency of urination at night.
  3. Patients should maintain a proper body weight since obesity may easily lead to weak abdominal muscles and increased abdominal pressure.
  4. Patients should avoid taking irritating foods, such as coffee, tea, alcohol, soda and cola, etc.
  5. On weekdays, patients should practice Kegel exercises more frequently to strengthen the pelvic floor and the contraction strength of the urethral muscle.
  6. 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.
  7. Smoking cessation: Long-term smoking can cause coughing and excessive bladder pressure, which may easily injure pelvic neuromuscular health.
  8. 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
  1. Hsiao, S. M. (2017). Update of the Conservative Treatment for Female Stress Urinary Incontinence. Formosan Journal of Medicine, 21(5), 481-484. 
  2. Li, C. H., Hsieh, P. L., Chen, W. (2016). Care for Urinary System Disorders. Chief Proofreader Hsueh-erh Liu, Adult Health Nursing (7th Edition, 857-864), Taipei City: Farseeing Publishing. 
  3. Long, C. Y. (2017). Update of Surgery for Female Stress Urinary Incontinence. Formosan Journal of Medicine, 21(5), 486-491. 
  4. 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. doi:10.1001/jama.2017.12137  
  5. Wang, P. H., Lin, C. L. (2016). Effectiveness of the Pelvic Floor Muscle Training for Women with Stress Urinary Incontinence Prevention and Improvement, Journal of Medicine and Health, 5(2), 21-30. 
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