Definition and Overview

Stress urinary incontinence (USI) is a condition in which a person loses control over his or her bladder. This causes them to leak urine before they can reach a bathroom. USI is very common. It occurs when a person performs movements that put pressure on a weakened pelvic floor or sphincter muscle. These movements include coughing, sneezing, and exercising.

USI is the most common type of incontinence in women. Its risk factors include pregnancy, more than one vaginal delivery, and obesity. Injury to the pelvic area and certain diseases can also cause it to occur.

USI is rarely serious. It does not lead to life-threatening situations. However, it can be very embarrassing and distressing for those who have it. It can prevent patients from doing the activities they enjoy. It can also cause them to avoid social situations due to fear and anxiety.

There are many available treatments to improve the symptoms of USI. These allow patients to live a normal life despite their condition.

Causes of Condition

In order to understand how female USI occurs, it is important to understand how the female urinary system works. This system consists of the following:

  • Kidneys - These are the organs that remove waste from the blood and produce urine.

  • Ureters - Urine from the kidneys pass through the ureter ducts to reach the bladder.

  • Bladder - The bladder collects and stores urine from the kidneys. When it is full, it contracts and pushes the urine through the urethra.

  • Sphincter muscle - This muscle controls the flow of urine. In normal circumstances, it remains tightly closed. When the bladder is full, it relaxes to allow the urine to flow out of the body.

USI occurs when the sphincter muscle is too weak to hold the urine. It can also occur if the pelvic floor muscles, which support the bladder, are damaged. This damage can be caused by a number of factors. The most common are pregnancy and childbirth. Hysterectomy also appears to increase a woman’s risk of USI. This surgery is used to treat many gynaecological conditions. These include uterine prolapse and heavy vaginal bleeding. It is a major operation that can weaken the pelvic floor muscles.

Advancing age is also known to increase the risk of USI. This is due to the natural weakening of the muscles. However, it is important to note that USI is not a normal part of ageing.

USI can also worsen due to a number of factors. These include obesity, chronic coughing, and high-impact activities. The list also includes chronic constipation, hormonal imbalance, and drinking too much caffeine and alcohol.

Key Symptoms

The main symptom of USI is the inability to control the urge to pee when performing some types of physical activity. The urine may leak when a person with USI coughs, sneezes, or exercises. They can also leak urine when changing their position from sitting to standing and vice versa.

Who to See and Types of Treatments Available

Female USI is treated by gynaecologists. These are doctors who specialise in the diagnosis and treatment of disorders and diseases that affect the female reproductive system.

USI is diagnosed using the following:

  • Review of medical history - The patient is asked if she has already given birth or had hysterectomy before. She is also asked if she is taking medications for another medical condition.

  • Physical exam - This exam focuses on the abdominal area. The doctor will look for signs of an enlarged bowel. The patient may be asked to cough or bear down with a full bladder.

  • Urinary stress test - This test simulates the accidental release of urine that may occur when a person sneezes, coughs, exercises, or laughs. Using a catheter, the doctor will fill the patient’s bladder with fluid. The patient is then asked to cough. The doctor will then note any fluid loss. The test can be done while the patient is lying down or standing up.

  • Urodynamic tests - The goal of these tests is to replicate the patient’s symptoms and determine what causes them to occur. The first part of the test uses a special toilet that checks how fast the urine flows. An abnormally slow flow rate indicates a problem with bladder emptying. The second part of the test is called cystometry. This is used to determine if there is a problem with the filling and emptying of the bladder.

The symptoms of female USI can be treated with internal urethral devices. These are inserted into the urethra to block the passage of urine. These devices can be useful during exercise and social gatherings. However, they have disadvantages. They can be uncomfortable and may increase the risk of urinary tract infection (UTI).

Vaginal pessaries can also be used. These are placed into the vagina to support and keep the pelvic organs in their correct position. In patients with USI, the device is used to support the base of the bladder.

USI can also be treated with a vaginal sling procedure. This surgery helps close the bladder neck and the urethra. It uses a tissue either from the patient’s body or a donor. A man-made material known as mesh can also be used. The procedure involves creating a small cut inside the vagina. Another incision is made in the groin or above the pubic line. A sling is then made from the tissue or synthetic material. The sling is attached to strong tissues in the area and passed under the bladder neck and urethra.

The surgery has a 70-95% long-term cure rate. It is not associated with serious complications. However, in rare cases, the urethra may become obstructed if the sling is tied too tightly.

References:

  • Urodynamic testing. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/health-topics/diagnostic-tests/urodynamic-testing/pages/urodynamic%20testing.aspx.

  • Ford AA, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006375.pub3/full.

  • Dmochowski RR, Osborn DJ, Reynolds WS. Slings: autologous, biologic, synthetic, and midurethral. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 84.

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