What is stress incontinence?
Incontinence is the loss of urine, a symptom with many causes. Stress incontinence is a type of leakage that occurs with increased abdominal pressure. This can happen with coughing, sneezing, laughing, straining or lifting.
Severe degrees of stress incontinence can be caused by even minor physical movements and be very bothersome to live with.
Stress incontinence can be related to poor support of the urethra, or lack of urethral function, or combinations of both.
Determining the cause in any patient may be the key to choosing the best options for treatment. Selection of treatment can and should be customized for the individual.
What are risk factors for SUI?
Genetics, aging, obesity, smoking, pregnancy, chronic cough (bronchitis and asthma) and childbirth can all play a role in causing SUI. Although SUI is much more common in women, men can also have the same problem, generally as a complication of prostate surgery.
Is SUI really a problem?
Urinary leakage is not a normal condition, and is often the source of discomfort, embarrassment, and leads to restricted physical activity and enjoyment of everyday life.
Knowing that the mother, sister or friend has stress incontinence and chooses to ignore it does not mean she has to do the same. The myth that incontinence is normal and a part of the aging process is false!
For most patients, the sooner they deal with the condition, the better they feel.
What can be done about SUI?
There are several different approaches depending on the specifics of the patient’s condition. These include behavioral interventions such as diet and exercises, or treatments guided by a therapist such as biofeedback or physical therapy.
In case of inconsistencies, there are no medications that are frequently used to treat SUI. Other options such as surgery can be very successful, and the procedures vary depending on the particulars of the problem and patient’s choices.
What should the patient expect when he comes for an appointment?
To start doctors will take a specialized history and perform a careful physical examination. If the patient had prior surgery for incontinence, it will be important to discuss.
Details of prior procedures along with a list of the current medications that will be given to doctor prior to the patient’s first appointment can be very helpful. This may allow some tests.
At first appointment, doctors will determine if the leakage can be seen during the examination if there is any evidence of other common female conditions such as prolapse, how well the patient is emptying the bladder, and whether if he can perform a Kegel exercise.
For most women, initial treatment options will be based on these factors. However, some patients require more testing to pinpoint their individual issues leading to leakage. X-rays, urodynamics (bladder function testing) or cystoscopy (looking inside the bladder with a telescope) may be necessary.
Most women are aware that exercises of the pelvic floor muscles or “Kegels” can help with symptoms of urinary leakage. In order to make the most of them, they need to be done correctly.
Should you choose this option for the problem, doctors offer a comprehensive program to help, which includes biofeedback or physical to help ensure your best treatment with the least invasive options.
Surgery can be the right choice for SUI. The procedures doctors most often offer for this problem are the simplest, safest, and most successful in history. They include mid-urethral and fascial slings and injection of bulking agents into the urethra.
In the majority of cases, when SUI is the only problem being corrected, the procedures are performed under “twilight anesthesia” as an outpatient. They are usually not very painful, don’t require catheters, and can have immediate benefits.