Bladder health

Stress urinary incontinence

What it is, what causes it, and how it is treated.

What is the pelvic floor?

The pelvic floor is a set of muscles that spread across the bottom of the pelvic cavity like a hammock. Three openings run through it: the urethra, the vagina, and the rectum. Its functions include:

• Supporting the pelvic organs, specifically the uterus, the bladder, and the rectum
• Helping provide sphincter control for the bladder and bowel
• Withstanding increases in abdominal pressure such as coughing, sneezing, laughing, straining, and lifting
• Enhancing the sexual response

What is stress urinary incontinence?

Stress urinary incontinence is the involuntary release of urine during laughter, coughing, lifting of objects, or any movement that increases pressure on your bladder.

Urine is composed of water, electrolytes, and other waste material filtered out of the blood by your kidneys. It travels through the ureters to your bladder, where it is stored. Once the bladder is full, the muscles in its wall contract, forcing urine through the urethra and out of your body. Sphincter muscles and pelvic floor muscles keep the urethra closed to avoid leakage, and they relax at the same time the bladder contracts so urine can exit.

Signs and symptoms include urine leakage caused by laughing, coughing, lifting, or any movement that increases pressure on the bladder.

What causes it?

Hormonal changes

During the week before your menstrual cycle, estrogen levels fall, causing symptoms to worsen. As a woman goes through menopause, estrogen levels also fall, causing the pelvic floor muscles to weaken. This results in less muscular pressure around the urethra, making stress urinary incontinence more likely.

Pregnancy

Hormonal changes and the enlarging uterus can cause stress urinary incontinence. During pregnancy, estrogen levels are lower, leading to less muscular strength in the sphincter and pelvic floor muscles, and as the fetus grows, extra weight is placed on your bladder.

Childbirth

Vaginal delivery can damage your pelvic floor muscles, making urine leakage more likely. The supporting tissues of your bladder can also be damaged, causing a cystocele, or prolapse of your bladder, symptoms of which include urinary incontinence. You may not know you have suffered damage until after menopause, when the pelvic floor muscles are further weakened by a fall in estrogen.

Hysterectomy and other surgery

The bladder and uterus are very close together and share supporting ligaments and muscles. Surgery to, or removal of, your uterus risks damage to the supporting structures of your bladder. If they are damaged, a cystocele is likely to occur, and its symptoms include urinary incontinence.

Illnesses

When you are ill and coughing severely, the pelvic floor muscles may fatigue and allow temporary stress incontinence due to the increase in abdominal pressure.

Obesity

Obesity can increase the abdominal pressure on the bladder, leading to urinary incontinence.

Bladder cancer or bladder stones

Symptoms include urinary incontinence, urgency, frequency, and painful urination. Other symptoms include blood in the urine and pelvic pain.

Neurological damage

Disorders such as multiple sclerosis, Parkinson’s disease, or stroke can cause urinary incontinence by interfering with the nerve signals that control your bladder. Damage to the nerves that supply your bladder or pelvic floor muscles may also result in incontinence.

How is it treated?

Treatment is tailored to your individual problem. The following should be considered:

Pelvic floor muscle strengthening

Strengthening the supporting muscles of your bladder is very effective. Biofeedback, the use of special computer equipment to measure muscle activity, can help improve muscle control. Electrical stimulation can also assist in strengthening the pelvic floor muscles.

Bladder training

Bladder training involves learning to delay the urge to urinate. You breathe deeply, relax, and distract yourself with another activity when you feel the urge. The initial goal is to delay urination by 10 minutes, increased in intervals until trips to the toilet are reduced to once every 2 to 4 hours. It may also involve learning to completely empty the bladder, often with double voiding: urinating, waiting a minute, and then urinating again.

Pessary

Pessaries can help when a cystocele or prolapsed bladder is the cause. A pessary is a device of various shapes and sizes placed in the vagina to support the bladder and keep it in place.

Urethral inserts

A urethral insert is a small tampon-like device placed in the urethra to avoid leakage. It is removed in order to urinate. It is not used for everyday activity but may help people who leak urine during sports.

Injections

Bulking material such as collagen may be injected into the urethra to help it close all the way.

Surgery

For severe cystoceles, or bladder prolapses, surgery is needed to correct the position of the bladder. Other surgeries for incontinence involve repositioning your urethra and bladder neck.

Sacral nerve stimulation

If neurological damage is the cause, implantation of a small device that electrically stimulates the nerves controlling the bladder and pelvic floor can help.

Prevention

To help prevent urinary incontinence, consider:

• Routine pelvic floor muscle strengthening exercises
• Not smoking
• Avoiding or correcting obesity and chronic cough
• Increasing your daily fiber and fluid to prevent constipation, a risk factor for urinary incontinence
• Avoiding bladder irritants such as alcohol and caffeine
• Staying physically active, since active people are less likely to develop urinary incontinence
• Discussing the possibilities and risks of estrogen replacement therapy with your physician

Coping with stress urinary incontinence

It can cause embarrassment, fear, anxiety, and social isolation. For these reasons it is important to take steps to address the problem. Seeking treatment can not only help with the problem, but also improve self-esteem and restore confidence. These everyday tips can also help:

• Take a change of clothes and clean-up supplies with you when you leave the house
• Use the restroom before you leave the house
• Locate public restrooms before you need them
• Wear a pad or disposable undergarments
• If odor is a problem, use a powder or deodorant
• If skin becomes irritated, consider a barrier cream