If you have stress incontinence, your bladder is not able to
hold urine as securely as it should, especially when under pressure. This means
that small amounts of urine are released when you sneeze, laugh, cough or
undergo sudden physical exercise, such as jumping or sexual activity.
The bladder is designed to hold urine securely until you
choose to visit the toilet and release it. This is achieved by a sphincter, a
tight band of muscle at the base of the bladder, just at the point where it
joins the urethra, the tube that carries urine out of the body. The bladder,
urethra and this important sphincter muscle are supported by the muscles of the
pelvic floor.
Stress incontinence can be due to problems with the
sphincter, or to a weakness of the muscles and surrounding tissues. Most people
experience stress incontinence occasionally, but for some people it becomes a frequent
and embarrassing problem.
What causes stress
incontinence?
Stress incontinence, also known as stress urinary
incontinence (SUI), affects around one in five women over 40. Men can also
suffer from stress incontinence but not nearly so many are troubled by it until
much later in life.
Three main causes are recognised:
-
Weakness in the muscles of the pelvic floor. These muscles can
lose tone during pregnancy, as a result of a hysterectomy or due to
advancing age. Drug prescriptions, such as muscle relaxants, and the drop
in oestrogen levels during menopause can also have an adverse effect on
the pelvic floor, leading to stress incontinence.
-
Damage to the sphincter muscle itself, or to its nerve supply.
Sphincter problems associated with stress incontinence can happen as a
result of abdominal surgery, a pelvic fracture or a radical prostatectomy
in men (performed as treatment for prostate cancer).
-
Overactive bladder. Muscles in the bladder wall are more
‘twitchy’ than normal, and tend to release the urine when they perceive
the bladder is dangerously fully. In fact, the bladder is not full and you
can train your bladder to stop recognising these signals quite so easily,
so reducing stress incontinence.
Treating stress
incontinence at home
The first stage of treatment for stress incontinence is to
remove triggers wherever possible. This includes stopping smoking, to prevent
smoker’s cough putting regular stress on the bladder, and losing weight, to
take the pressure off the pelvic floor muscles. Something as simple as watching
what you drink and when, and making sure you don’t leave it too long before
going to the toilet can all help stress incontinence.
The next step in many cases is to improve the muscle tone of
the pelvic floor. Your GP, stress incontinence specialist nurse or
physiotherapist will tell you how to do pelvic floor exercises effectively several
times a day, to strengthen the muscles. The basic technique is to imagine you
are urinating and to then contract the muscles in your pelvis that will stop
the flow completely, even though the bladder is still reasonably full. Paying
attention to the muscles you use should enable you to contract these muscles at
will, wherever you are.
If your stress incontinence persists, several training
techniques and alternatives are available:
-
Biofeedback: a device that signals when you are squeezing the
right muscles, to help you learn the correct techniques. Once you have had
biofeedback, you will be much more aware of how to do pelvic floor
exercises effectively.
-
Vaginal cones: these small, cone-shaped weights are inserted
into the vagina to help you to train your pelvic floor muscles. Just
holding them in while standing up contracts the correct muscles.
-
Bladder training: you will be told how to train your bladder
to get used to holding more urine without releasing it spontaneously. This
involves ‘holding on’ for an extra minute or two, and avoiding the urge to
urinate for longer and longer periods. This can work well for people whose
stress incontinence is due to an overactive bladder.
-
Electrical muscle stimulation: this stimulates and tones the
pelvic floor muscles for you if you are unable to tense and relax them
yourself.
Medication for stress
incontinence
Strengthening the pelvic floor is sufficient to treat stress
incontinence in around 60% of cases. If this doesn’t solve the problem then you
may require drug treatment or surgery.
Currently, the National Institute of Clinical Excellence (NICE)
recommends that an immediate release formulation of the drug oxybutynin should
be used as a drug treatment for women with stress incontinence, but only after
pelvic floor exercises and methods of training the bladder have failed.
If this also doesn’t work, you can be prescribed other drugs
such as tolterodine, solifenacin, darifenacin or trospium, or you can have an
oxybutynin skin patch, which releases the drug slowly but constantly. This can produce
better results in some women.
Surgical treatments
for stress incontinence
The aim of surgery for stress incontinence is to give you
more control over your bladder, but it may not always offer a complete cure.
The long-term effectiveness of surgery for stress incontinence depends on
several factors including the original cause, your lifestyle and the type of
surgery you have. Your doctor will advise on the option most suitable for you.
Surgical solutions for stress incontinence include:
-
Colposuspension: this involves constructing a hammock-like
structure within the abdomen to provide additional support for the
urethra.
-
Tape insertion: this involves inserting tape to form a
supportive sling for the bladder and urethra. You may have a
transobturator tape or TOT procedure or a tension-free vaginal tape or TVT
procedure.
-
Urethral bulking agents: injections of collagen are given to
thicken and strengthen the walls of the urethra to help prevent urine
leakage.
-
Artificial sphincter implant: a technique that can be offered
to men to replace the natural sphincter. Some types are in development,
but this is not a routine, mainstream technique for treating stress
incontinence.
