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    Stress Incontinence

     Overview
    Causes and Risks
    Treatment
    Frequently Asked Questions
     Where To Seek Treatment

     


    Contributed by Singapore General Hospital

    Overview

    Stress incontinence is the involuntary loss of urine when there is an increase in abdominal pressure (e.g., during coughing or exercise). It is a common disorder with 20% of women suffering from stress incontinence at one time or another.

    The inconvenience it causes varies from woman to woman. In most cases treatment of stress incontinence is simple, however, a small number of women may require surgical treatment.

    Nearly all women with stress incontinence can either be cured or the degree of incontinence much improved. 

    The urinary system

    Urine produced in the kidneys is passed via the ureters to the bladder where it is stored until it is convenient for it to be emptied. The bladder is simply a muscular bag that expands to store up to 300-500 ml of urine.

    When you pass urine the bladder contracts. Most women empty their bladder 4-6 times a day passing 200-300ml of urine each time The urethra is the outlet from the bladder. It passes through the pelvic floor muscles in front of the vagina. These muscles act like a control valve around the urethra. They tighten when you cough or exercise and relax when urine is passed. 

    Causes and Risk

    In most cases it is due to a weakness of the pelvic floor muscles and is more common in women who have delivered children but also may be due to lack of exercise or simply getting older. Weakness of the pelvic floor muscles may be associated with a prolapse of the bladder into the vagina.

    Leakage of urine may also be due to urge incontinence. It is due to an involuntary bladder contraction (detrusor instability) and its treatment is different from stress incontinence. There are other rare causes of incontinence, the doctor will assess you to exclude them.  

    Treatment

    The type and severity of incontinence varies from woman to woman. Each individual needs a treatment plan designed especially for them. Incontinence is often worse if you are overweight, have a cough or a urine infection and after the menopause. The doctor may treat these problems first. You may even have more than one type of incontinence that needs treating.

    Pelvic Floor Exercises

    One of the most common treatments is pelvic floor exercises. These exercises help to improve your bladder control. When done correctly pelvic floor exercises strengthen the pelvic floor muscles that prevent urine from leaking. The more often that you do your exercises the better your control will be.

    The pelvic floor muscles stretch like a hammock across the pelvis and help to hold the uterus (womb), bladder and bowel in place. These muscles also act like a control valve around the urethra. They tighten when you do something to raise your abdominal pressure (e.g., coughing) to prevent any urine from leaking. They relax when you want to pass urine.

    There are several ways of exercising and strengthening the pelvic floor muscles. In the beginning it is often it is better to see a physiotherapist who will teach you how to do the exercises properly. The physiotherapist can see you at intervals to monitor your progress and to suggest different ways of strengthening the pelvic floor muscles. Remember: pelvic floor exercises work if you stick at it. You must continue your exercises after your symptoms have improved.

    Other treatments

    Some women are prescribed tablets or given vaginal creams. If surgery is indicated your doctor will discuss this carefully with you. It is not uncommon to need more than one treatment.  

    Frequently Asked Questions

    Is my incontinence unhygienic?

    Urine is normally sterile and doesn't carry infection, however, if left on the clothes or shin it not only smells unpleasant but irritates the skin as well. Each time you need to change wet pads or clothing wash yourself with a mild soap and warm water. If you wear pads change them regularly, a barrier cream may help to prevent soreness.

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