Stress incontinence : Causes-Symptoms-Diagnosis-Treatment

What is Stress Incontinence?

Urinary stress incontinence occurs when a sudden activity such as coughing, sneezing, or exercising causes a small amount of urine to leak from the urethra. This can be a type of incontinence called stress incontinence (SI). It is most common among women and can affect them in many ways. All ages are vulnerable. Older women are particularly at risk, as well as women who have recently given birth. Women who are under a lot of stress can experience urinary leakage.

Stress Incontinence

Stress incontinence is the most typical form of urinary incontinence. It causes you to leak piss throughout physical exertion. It can happen during exercise, coughing, happiness and sneezing. girdle floor exercises (Kegels) can strengthen muscles and cut back symptoms. Some individuals would like pessaries, bladder slings or different treatments.Stress incontinence causes urine to leak once one thing puts pressure on your bladder (the organ within the genitourinary system that holds pee). you'll unharness tiny amounts of urine after you cough, sneeze or laugh. Exercise like jumping, running or lifting an important object may also cause you to pee.Stress incontinence is the most common form of incontinence. It most frequently has an effect ons the genitourinary system in individuals allotted feminine at birth (AFAB). As several as one in three people that were AFAB can experience stress urinary incontinence at some point. It’s less common for the condition to affect men, however it will happen.More than half people with urinary incontinence even have urinary incontinence. Having each stress and urge incontinence is thought as mixed incontinence. Associate in Nursing active bladder causes urge incontinence. This kind of urinary incontinence causes you to leak piss after you feel an imperative ought to pee.

Overflow incontinence may be a totally different form of urinary incontinence. It causes you to leak piss as a result of your bladder being just too full otherwise you can’t fully empty it.

1. Urinary system

1. Kidneys

2. Ureter

3. Bladder

4. Urethra

Medical terms

• Urinary incontinence is the unintentional loss of urine. Enuresis happens once physical movement or activity — akin to coughing, laughing, sneezing, running or work — puts pressure (stress) on your bladder, inflicting you to leak urine. Enuresis isn't related to psychological stress. enuresis is totally different from urgency incontinence and hyperactive bladder (OAB). If you have got urgency incontinence or OAB, your bladder muscle contracts, causing an explosive urge to urinate before you'll be able to get to the bathroom. Enuresis is far more common in ladies than in men. If you have stress incontinence, you will feel embarrassed, isolate yourself, or limit your work and social life. you will conjointly avoid physical and leisure activities. With treatment, you'll probably be able to manage enuresis and improve your overall well-being.
• Studies show that staying hydrated actually helps alleviate the most common symptoms of urinary incontinence: stress and urge incontinence In fact a study published in the Journal of Urology showed that just over half of women who had been practicing Kegel exercises for several weeks reported improvement in bladder control Another 2009 study published in the same journal found that a three-week water regimen led to significant improvements in bladder function self-perception and quality of life among women with overactive bladder syndrome And according to a report on WebMD fluids can help reduce frequency and urgency associated with urge incontinence. 

Symptoms Stress incontinence

Leaking excreta once there’s pressure on your bladder is the prime sign of urinary incontinence. Gentle stress incontinence may cause you to leak drops of urine throughout activities like serious exercise, laughing, coughing or sneezing. With moderate to severe stress incontinence, you'll leak quite a tablespoon of urine even during less strenuous activities like standing up or bending over. you'll even leak urine whereas having sex.

If you have stress incontinence, you may leak urine when you:

• Cough or sneeze

• Laugh

• Bend over

• Lift something heavy

• Exercise

• Have sex

You may not leak piss whenever you are doing one of these things. But, any activity that puts pressure on your bladder will create involuntary urine loss additionally, significantly when your bladder is full.

When to see a doctor

Talk to your health care supplier if your symptoms trouble you or interfere with daily activities, resembling your work, hobbies and social life.

Causes Stress incontinence

Stress incontinence is a condition in which urine leaks when someone is physically active or moved. Common symptoms of stress incontinence include a drop or two of urine during physical activity, a squirt or stream of urine, and frequent leakage. Pee should be collected in a pot. 

Stress causes incontinence. This can be seen in movements such as coughing, sneezing, and lifting, which put increased abdominal pressure on the bladder. This then causes leakage of urine.

Stress incontinence can be caused by problems with the muscles that control bladder and bowel function. These problems can also occur if the sphincter muscle at the neck of the bladder doesn't work correctly. Chronic coughing can also contribute to this problem. Smoking and obesity can also lead to sleep apnea.

Stress incontinence is often caused by physical changes in the body. These changes can include:

• Pregnancy and childbirth

• Menstruation

• Menopause

• Pelvic surgery

• Urinary problems can include muscle problems in the bladder and the urethra.

• Weakened muscles around the bladder

If someone has stress incontinence, their muscles in their pelvis can weaken. This can cause the bladder to drop down into a position that prevents the urethra from closing completely. When this happens, urine leaks out.

Stress incontinence occurs when the muscles and other tissues that support the urethra (pelvic floor muscles) and the muscles that control  urine output (urinary sphincters) weaken.

 The bladder expands as it fills with urine. Normally, the valve-like muscles in the urethra, the short tube that carries urine out of your body, stay closed when the bladder expands, preventing urine from escaping until it reaches the bathroom. But when these muscles weaken, anything that puts force on the abdominal and pelvic muscles (eg, sneezing, bending over, lifting objects, or laughing hard) can put pressure on the bladder and cause urine leakage.

Your pelvic floor muscles and urinary sphincter may lose strength because of:

• Childbirth. In women, tissue or nerve harm throughout delivery of a baby will weaken the girdle floor muscles or the sphincter. Urinary incontinence from this damage might begin before long once delivery or occur years later. 

• Prostate surgery. In men, the surgical removal of the ductless gland to treat willcer|prostatic adenocarcinoma|adenocarcinoma|glandular cancer|glandular carcinoma} (prostatectomy) is the commonest issue resulting in stress incontinence. This procedure can weaken the sphincter, which lies directly below the prostate gland and encircles the urethra. 

Contributing factors

Other factors that may worsen stress incontinence include:

• Illnesses that cause chronic coughing

• Obesity

• Smoking, which can cause frequent coughing

• High-impact activities, such as running and jumping, over many years

Risk factors Stress incontinence

Factors that increase the risk of developing stress incontinence include:

• Age. Physical changes that occur as you age, like the weakening of muscles, could cause you to develop urinary incontinence. However, occasional stress incontinence will occur at any age. 

• Type of childbirth delivery. Women who've had a canal delivery are more likely to develop incontinence than women who've delivered via a cesarean section. ladies who've had a delivery to quickly deliver a healthy baby may additionally have a bigger risk of stress incontinence. ladies who've had a vacuum-assisted delivery don't seem to possess a better risk for stress incontinence. 

• Body weight. People who are overweight or rotund have a better risk of stress incontinence. Excess weight will increase pressure on the abdominal and girdle organs. 

• Previous pelvic surgery. Hysterectomy in ladies and surgery for willcer|prostatic adenocarcinoma|adenocarcinoma|glandular cancer|glandular carcinoma} in men can weaken the muscles that support the bladder and urethra, increasing the chance of stress incontinence. 

Complications Stress incontinence

Complications of stress incontinence may include:

• Emotional distress. If you experience enuresis along with your daily activities, you'll feel embarrassed and distressed by the condition. It will disrupt your work, social activities, relationships and even your sex life. Some individuals are embarrassed that they have pads or incontinence garments. 

• Mixed urinary incontinence. Mixed incontinence is commonly associated with implies that you have got each enuresis and urgency incontinence — the unintentional loss of water ensuing from bladder muscle contractions (overactive bladder) that cause a pressing ought to urinate. 

• Skin rash or irritation. Skin that's perpetually up-to-date with body waste may get irritated or sore and might break down. This happens with severe incontinence if you don't take precautions, equivalent to victimization wetness barriers or incontinence pads. 

Diagnosis Stress incontinence

Your tending supplier will perform a physical test (and a girdle exam for individuals AFAB) and raise regarding symptoms. You'll have to keep a bladder diary for 2 to a few days to watch your fluid intake, toilet use and excrement leakage. Your notes ought to embody what you were doing before the leakage. This info will facilitate your provider build a diagnosis.During your visit, your health care provider appears for clues that will indicate conducive factors. Your appointment will probably include a:

• Medical history

• Physical exam, which may include a rectal exam and a pelvic exam in women

• Urine sample to test for infection, traces of blood or other abnormalities

• Brief neurological exam to identify any pelvic nerve problems

• Urinary stress test, in which the provider observes urine loss when you cough or bear down

Tests of bladder function

Common cases of incontinence sometimes don't need further tests. However, in some cases, your supplier would possibly order tests to assess however well your bladder, channel and anatomical sphincter are functioning (urodynamic tests).

Bladder function tests may include:

• Measurements of post-void residual urine. Your supplier may advocate this check if there' concern regarding your ability to empty your bladder completely, significantly if you're older, have had previous bladder surgery or have diabetes. This test can tell however well your bladder is functioning. A specialist uses an ultrasound scan, that interprets sound waves into an image, to look at what proportion weewee is left in your bladder when you urinate. In some cases, a skinny tube (catheter) is seen through the epithelial duct and into your bladder. The tube drains the remaining urine, which might then be measured. 

• Measuring bladder pressures. Cystometry could be a check that measures pressure in your bladder and within the close region as your bladder fills. Your supplier may suggest this test to examine for enuresis if you've had a neurological unwellness of the spinal cord. A tubing is employed to fill your bladder slowly with heat fluid. As your bladder fills, you'll be asked to cough or bear right down to test for leaks. This procedure could also be combined with a pressure-flow study, that tells what proportion pressure your bladder needs to exert so as to empty completely. 

• Creating images of the bladder as it functions. Video urodynamics could be a take a look at that uses imaging to form pictures of your bladder as it's filling and emptying. Heat fluid mixed with a dye that shows au courant X-rays is step by step instilled in your bladder by a tube whereas the photographs are recorded. Once your bladder is full, the imaging continues as you urinate to empty your bladder. 

• Cystoscopy. This check uses a scope that's inserted into the bladder to seem for blockages or any abnormalities within the bladder and urethra. This procedure is typically completed in the office. You and your supplier ought to discuss the results of any tests and judge however they impact your treatment strategy. 

Treatment Stress incontinence

Yes, girdle floor exercises (Kegels) will improve stress incontinence. These exercises strengthen the muscles that support your urinary system. It is difficult to properly work and strengthen your pelvic floor muscles. A physiotherapist who focuses on pelvic floor disorders can assist you master the correct techniques. This supplier might use a training program to confirm you're employing the right muscles. It can take four to 6 weeks of standard exercise to check if symptoms improve.Your health care provider may suggest a mix of ways to treat incontinence. If an underlying cause or contributing factor, resembling a urinary tract infection, is identified, you'll conjointly receive treatment for the condition.

Behavior therapies

Behavior therapies could assist you eliminate or reduce episodes of stress incontinence. The treatments your doctor recommends may include:

• Pelvic floor muscle exercises. Your supplier or healer will assist you find out how to try to do physical exercise to strengthen your girdle floor muscles and urinary sphincter. a bit like the other exercise routine, how well Kegel exercises work for you depends on whether or not you perform them regularly. A way known as a training program is used in conjunction with Kegel exercises to create a lot of effectiveness. The training program involves the employment of pressure sensors or electrical stimulation to strengthen the correct muscle contractions. 

• Fluid consumption. Your supplier may advocate what proportion and after you ought to consume fluids throughout the day and evening. However, don't limit what you drink most that you just become dehydrated. Your provider may additionally  counsel that you avoid caffeinated, effervescent and alcoholic beverages, which can irritate and have an effect on bladder operation in some people. If you discover that victimization fluid schedules and avoiding sure beverages considerably improve leakage, you'll have to be compelled to decide whether or not creating these changes in your diet are worth it. 

• Healthy lifestyle changes. Quitting smoking, losing excess weight or treating a chronic cough will lessen your risk of stress incontinence and improve your symptoms.

• Bladder training. Your supplier may advocate a schedule for toileting if you have got mixed incontinence. A lot of frequent elimination of the bladder may cut back the amount or severity of urinary incontinence episodes. 

Medications

There are not any approved medications to specifically treat enuresis within the United States. The medication duloxetine (Cymbalta, Drizalma Sprinkle) is employed for the treatment of stress incontinence in Europe, however. Symptoms quickly come back once the drug is stopped. Nausea is that the commonest facet result that produces folks stop taking the medication.

Devices

Certain devices designed for women may help control stress incontinence, including:

• Vaginal pessary. A specialized incontinency contraceptive device, formed sort of a ring with 2 bumps that sit on both sides of the urethra, is fitted and placed into place by your provider. It helps support your bladder base to forestall weewee outpouring throughout activity, particularly if your bladder has developed (prolapsed). This is often an honest alternative if you want to avoid surgery. A pessary would force routine removal and cleaning. Pessaries are used largely in those that even have girdle organ prolapse. 

• Urethral inserts. This little tampon-like disposable device inserted into the duct acts as a barrier to stop leakage. It's typically used to prevent incontinence throughout a particular activity, however it should be worn throughout the day. canal inserts will be worn for up to eight hours a day. canal inserts are usually used just for serious activity, appreciate perennial lifting, running or enjoying tennis. 

Surgery

Surgical interventions to treat enuresis are designed to enhance closure of the sphincter muscle or support the bladder neck. Surgical choices include:

• Sling procedure. This is the foremost common procedure performed in ladies with stress urinary incontinence. During this procedure, the medico uses the person' own tissue, artificial material (mesh), or animal or donor tissue to form a sling or hammock that supports the urethra. Slings are used for men with delicate enuresis. The technique might ease symptoms of stress incontinence in some men. 

• Injectable bulking agents. Synthetic polysaccharides or gels are also injected into tissues round the higher portion of the urethra. These materials bulk up the realm around the urethra, up the closing ability of the sphincter. 

• Retropubic colposuspension. This surgical treatment uses sutures connected to ligaments on the os pubis to elevate Associate in Nursing support tissues close to the bladder neck and higher portion of the urethra. This surgery may be done laparoscopically or by an incision within the abdomen. 

• Inflatable artificial sphincter. This surgically deep-seated device is employed to treat men. A cuff, which inserts round the higher portion of the urethra, replaces the operation of the sphincter. Tubes connect the cuff to a pressure-regulating balloon within the girdle region and operated by hand pump in the scrotum. 

Lifestyle and home remedies

Healthy lifestyle practices can ease symptoms of stress incontinence. These include:

• Shed extra weight. If you're overweight — your body mass index (BMI) is twenty five or higher — losing excess pounds will facilitate the pressure on your bladder and girdle floor muscles. Moderate weight loss might markedly improve stress incontinence. discuss with your doctor for steering on weight loss. 

• Add fiber to your diet. If chronic constipation contributes to your urinary incontinence, keeping internal organ movements soft and regular reduces the strain placed on your girdle floor muscles. strive ingestion high-fiber foods — whole grains, legumes, fruits and vegetables — to alleviate and forestall constipation. 

• Avoid foods and beverages that can irritate your bladder. If uptake of chocolate or drinking coffee, tea (regular or decaf) or effervescent beverages appears to form you urinate and leak additional frequently, attempt eliminating that drink, particularly on days you actually don't wish to be decomposed by leakage. 

• Don't smoke. Smoking can result in a severe chronic cough, which might irritate the symptoms of stress incontinence. Smoking is additionally an element in several cases of bladder cancer. 

Coping and support

Treatments for urinary incontinence will usually well reduce, and presumably eliminate, excretory product leak. Some individuals can still have urine leakage each currently and then. Being ready could assist you cope.

Going out and about

Maintaining your reference to family, friends and associates can stop feelings of isolation and depression that {may} accompany incontinence. Being ready may assist you feel more leisurely once you're out and about:

• Stock up on supplies. Take on enough incontinence pads or protecting undergarments and presumably an amendment of garments. Incontinence merchandise are discreet and may be stowed in a very commodious  purse or atiny low backpack. further provides and spare clothes are unbroken within the trunk of your automotive or a backpack to be used once needed. 

• Scout out your destination. Familiarize yourself with the restrooms available at your destination. Choose seating that allows easy access to restrooms.

• Take good care of your skin. Prolonged contact with wet consumer goods will cause skin irritation or sores. Keep your skin dry by dynamical your clothes once they're wet and applying a barrier cream if your skin is usually wet. 

Sexuality and incontinence

Leaking water throughout sexual activity is upsetting, however it doesn't essentially need to get within the approach of intimacy and enjoyment:

• Talk with your partner. As tough as this might be initially, be direct together with your partner concerning your symptoms. A partner' understanding and temperament to accommodate your desires will create your symptoms a lot easier to handle. 

• Empty your bladder beforehand. To reduce your chances of leakage, avoid drinking fluids for an hour or so before sex and empty your bladder before intimacy starts.

• Try a different position. Altering positions may make leakage less likely for you. For women, being on top generally gives better control of the pelvic muscles.

• Do your Kegel exercises. These exercises strengthen your pelvic floor muscles and reduce urine leakage.

• Be prepared. Having towels handy or using disposable pads on your bed may ease your worry and contain any leakage.

Seek help

Incontinence isn't a traditional part of aging. Treatments are sometimes on the market to cure or considerably scale back the consequences of enuresis on your life. notice a health care supplier who's willing to figure with you to see the most effective thanks to treat your incontinence. selecting the correct treatments for you ought to be a partnership between you and your offer. Take time to debate the professionals and cons of the various treatment choices along with your provider. Think about connecting with a support group. Support teams provide a chance to voice considerations and sometimes provide motivation to maintain self-care strategies. Organizations comparable to the National Association for Continence provide resources and knowledge for folks that have stress incontinence.

Preparing for your appointment

Your health care supplier may have you ever fill out a form to form a preliminary assessment of your urinary incontinence symptoms. you'll even be asked to stay a bladder diary for many days. In a very bladder diary, you record once, what quantity and what reasonably fluids you consume, still as when and the way much you urinate and after you experience incontinence episodes. Your diary may reveal patterns that facilitate your provider perceive your symptoms and determine causative factors. This might cut back the necessity for more invasive testing. specialized testing may require referral to a specialist in urinary disorders for men and ladies (urologist) or a specialist in urinary disorders in women (urogynecologist).

What you can do

To get the most from your visit to your health care provider, prepare in advance:

• Make a list of any symptoms you're experiencing. Include when urine leakage occurs.

• Make a list of any medications, herbs or vitamin supplements you take. Some over-the-counter supplements will irritate the urinary tract. embody doses and the way usually you're taking the medication. 

• Have a family member or close friend accompany you. You may be given a lot of information at your visit, and it can be difficult to remember everything.

• Prepare a list of questions to ask your provider. List your most important questions first to be sure you cover those points.

For urinary incontinence, some basic questions to ask your provider include:

• Will my urinary incontinence get worse?

• Could pelvic floor exercises help me? How do I do them?

• How does my weight affect my condition?

• Could the medicines I take be aggravating my condition?

• What tests might I need to determine the cause of my incontinence?

• Will I need surgery?

Don't hesitate to ask other questions as they occur to you during your appointment.

What to expect from your doctor

Be prepared to answer questions from your provider. Questions your provider might ask include:

• How often do you leak urine?

• When you leak urine, is it a few drops or are your clothes soaked?

• Are there times when you know that you will leak?

• Do you leak urine when you exercise?

• Do you wake up during the night to urinate? How often?

• What's your typical daily fluid intake?

• Does anything seem to make your incontinence better? How about worse?

• What bothers you most about your urinary incontinence?

• Do you also have bowel leakage? How often? Does this cause you to restrict your activities?

• Does it seem as if there's something "falling out" of your pelvis or vagina?

General summary

1. The first line treatment for stress incontinence is to change the diet of the patient This could help by increasing activity in the muscles used for bladder control and preventing further weakening of these muscles as a result of a sedentary lifestyle The patient should also reduce strenuous activities and increase physical exercise These changes in lifestyle would help strengthen the pelvic floor muscle which supports the structure of the bladder.
2. If you have stress incontinence or leakage of urine with laughing sneezing and other physical movement your doctor may recommend a few natural remedies to help relieve symptoms One of the most common is drinking cranberry juice Another is increasing your water intake to help keep your bladder from contracting when it is not full If these methods don’t work for you talk with your doctor about prescription medications that can minimize the amount of urine leakage you experience.