Stress Incontinence


Stress Incontinence

Description, Causes and Risk Factors:

ICD-9-CM: 788.32.

Stress incontinence is an involuntary loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, or exercise.

Stress incontinence is the most common form of urinary incontinence. It is estimated that about three million people in the UK are regularly incontinent. Overall this is about 4 in 100 adults, and well over half of these are due to stress incontinence. Stress incontinence becomes more common in older women and as many as 1 in 5 women over the age of 40 have some degree of stress incontinence.

The ability to hold urine and control urination depends on the normal function of the lower urinary tract, the kidneys, and the nervous system. You must also have the ability to recognize and respond to the urge to urinate.

In stress incontinence, the sphincter muscle and the pelvic muscles, which support the bladder and urethra, are weakened. The sphincter is not able to prevent urine flow when there is increased pressure from the abdomen (such as when you laught, cough, or lift something heavy).

Stress incontinence may occur as a result of weakened pelvic muscles that support the bladder and urethra or because of a malfunction of the urethral sphincter. The weakness may be caused by, injury to the urethral area, surgery of the prostate or pelvic area.

Symptoms:

The main symptom of stress incontinence is involuntary loss of urine. It may occur when:

    Sneezing.

  • Coughing.

  • Standing.

  • Exercising.

  • Engaging in other physical activity.

  • Engaging in sexual intercourse.

You may not experience incontinence every time you do one of these things, but any pressure-increasing activity can make you more vulnerable to unintentional urine loss, particularly when your bladder is full.

Diagnosis:

During a basic diagnostic workup your doctor looks for clues that may also indicate contributing factorsm, which include:

    Genital exam in men.

  • Pelvic exam in women.

  • Rectal exam.

Tests may include:

    Cystoscopy.

  • Pelvic or abdominal ultrasound.

  • Post-void residual (PVR) to measure amount of urine left after urination.

  • An electromyogram (EMG) is performed to study muscle activity in the urethra or pelvic floor.

  • Urinalysis or urine culture to rule out urinary tract infection.

  • Urinary stress test (the patient is asked to stand with a full bladder, and then cough).

  • X-rays with contrast dye of the kidneys and bladder.

The health care provider may also measure the change in the angle of the urethra when at rest and when straining (Q-tip test). An angle change of greater than 30 degrees often means there is significant weakness of the muscles and tissues that support the bladder.

Treatment Options:

There are three major categories of treatment for stress incontinence:

Pelvic Muscle Exercises: Pelvic muscle exercises, also known as Kegels, can help improve incontinence and prevent it from worsening. They can help you suppress the urge to urinate. The exercises strengthen and tone the muscles that support the pelvic organs. These muscles contract and relax under your command to control the opening and closing of the bladder. When these muscles are weak, urine leakage may occur. To achieve the best results, imagine yourself as an athlete in training. You need to build strength and endurance of your muscles. This requires commitment and regular exercise. Correct technique also is very important.

Sit in a chair with your knees slightly apart. Imagine you are trying to stop wind escaping from your anus (back passage). You will have to squeeze the muscle just above the entrance to the anus. You should feel some movement in the muscle. Don't move your buttocks or legs.

Now imagine you are passing urine and are trying to stop the stream. You will find yourself using slightly different parts of the pelvic floor muscles to the first exercise (ones nearer the front). These are the ones to strengthen. If you are not sure that you are exercising the right muscles, put a couple of fingers into your vagina. You should feel a gentle squeeze when doing the exercises.

Medications: Medicines tend to work better in patients with mild to moderate stress incontinence. There are several types of medications that may be used alone or in combination. They include:

Anticholinergic agents (oxybutynin, tolterodine, enablex, sanctura, vesicare, oxytrol) Antimuscarinic drugs block bladder contractions (many doctors prescribe these types of drugs first) Alpha-adrenergic agonist drugs, such as phenylpropanolamine and pseudoephedrine (common ingredients in over-the-counter cold medications), help increase sphincter strength and improve symptoms in many patients Imipramine, a tricyclic antidepressant, works in a similar way to alpha-adrenergic drugs.

Surgery: Various surgical operations are used to treat stress incontinence. They tend only to be used when the pelvic floor muscle exercises have not helped. The operations aim to 'tighten' or support the muscles and structures below the bladder. Surgery is often successful.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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