Urinary Incontinence and Stress

What is stress incontinence?

Stress incontinence means involuntary loss of urine (urinary leakage) during coughing, sneezing, or other activities, which increases the pressure in the abdominal cavity. It is usually small amounts of urine leaking at a time.

It divides incontinence in three grades:

• Easy – drop leakage 1-2 times a month
• Moderate – daily drop leakage
• Serious – larger leakage amounts at least once a week

How common is stress incontinence?

Involuntary urination is a very common problem. In South Africa, a third (33%) of all adult women over 45 involuntary urination. Also foreign studies show that this is a frequent condition. The condition is most frequently around the menopause.

Stress incontinence account for half of all cases of incontinence. 35-50% have a mixture of stress urinary incontinence and urgency incontinence . Urgency incontinence or urge incontinence is a sudden and strong urge to urinate, which often leads to greater urine leaks. In older you often see a mix of stress and urgency incontinence.

What causes stress incontinence?

The main causes of stress incontinence are births, estrogen deficiency and prolapse of the vagina or uterus . These conditions lead to impaired muscle or close the closure mechanism at the end of the urinary bladder. This is due to damage or weakening of the bladder neck, upper part of the urethra or pelvic floor.

What are the symptoms of stress incontinence?

Involuntary loss of urine for coughing sneezing or lifting.

What symptoms should you pay particular attention to?

If urinary incontinence occurs without concomitant urinary urgency, these are usually about stress incontinence.

How is it diagnosed?

The doctor makes the diagnosis based on the typical medical history. A gynecological examination may be normal. After the menopause, there may be signs of estrogen deficiency in the form of thinner tissue and / or prolapse of the vaginal or uterine.

To the doctor can identify what type of incontinence it comes, it can be of great help to you keep a chart of urination .

In most cases, make one’s own doctor the necessary assessments in the form of medical history, examination of the abdomen and control of urine. The diagnosis is then usually so obvious that one’s own doctor can start treatment.

If there is uncertainty about the diagnosis or treatment does not help, it may sometimes be necessary to refer you to a more thorough investigation. This is done by a so-called urodynamic study. It is a study that maps the closing and evacuation conditions of the bladder.

A urodynamic study is used to identify how well the muscles in the bladder, and especially the sphincter works. The study shows how big your bladder capacity, ie the amount of the urinary bladder can accommodate. It also shows how good the control you have over your bladder at different degree of filling. Eg. for even small amounts of urine leads to urinate. The study also says the bladder fills and empties itself in the normal way.

Keyhole examination of the bladder may also be a possibility to see the lining of the bladder is normal.

What treatment is there?

What can you do yourself?

There are several things you can do to improve the situation:

• Be sure to take normal amount of beverages, ie 1-2 liters a day
• Urination with less than 3-4 hour intervals
• avoid constipation
• Try to have regular toilet habits and empty the bladder when needed. For example it is a good idea to leave the water before the effort, as you know can lead to incontinence
• Avoid obesity. If you are overweight, you should lose weight
• Chronic cough is also a major problem, as this may cause involuntary loss of urine. Smoking cessation and good treatment of asthma and bronchitis is therefore necessary

Pelvic floor exercise

Pelvic floor exercise is the main treatment for better involuntary urination.

To strengthen the muscles in the bladder and pelvic should perform regular pelvic floor exercises. This is done by pinching together as if you had to stop your urine stream during urination. Continue this for about 5 minutes. Repeat it at least a few times a day – for example, 8-12 strong contractions three times each day. Each pinching should last for 5-10 seconds, followed by an equally long period of relaxation.

If the exercises are performed correctly, the treatment is effective, simple, without side effects and cost. However, it takes time before pelvic floor exercises help, which can inhibit motivation. The effect ceases if one ends with exercises.

mechanical aids

• Pinch-egg is a kind of weights of different weight, which is placed in the vagina. They are both elongated and round version; Both types have the same effect. They seem acceptable in that the weight pressing against the pelvic floor and thereby provide nerve signals, which causes you to pinch nip to hold the egg in place. You can try to use pinch-eggs while performing pelvic floor exercises. It increases the effect of training
• Ringpessar used especially in cases where there is uterine prolapse or bladder hernia and in women who can not or do not want surgery. Older women must also have estrogen to prevent ulceration
• Tampon (menstrual or custom type) forms support against the bladder, urethra and rectum. This can help in mild cases and in connection with physical activity

Electrical Stimulation

Electrical stimulation has been in use since 1960. One uses small electronic devices which deliver power with a frequency of 20-50 Hz for short pulse shock. Normally, these electrodes are placed in the vagina. The flow stimulates the muscles of the pelvic floor and the urethra, both directly and indirectly. The stimulation can be carried out in different ways, mainly as long-term stimulation (gentle current), or maximal stimulation (a current).

The weakest types of apparatus can operate themselves. This is done in the form of long-term stimulation with an apparatus which is intended for home 6-8 hours a day for 3-6 months. The second method is maximal stimulation. This requires a special device that you use for 20 minutes 1-2 times a day.

It is uncertain whether there is any specific long-term. The treatment is safe and without harmful effects but little used.

other aids

There are also various other aids for those who suffer from stress incontinence in the form of diapers, special briefs and sheet protectors. At the pharmacy and in specialist health articles can also get useful guide. Several of the aids provided free from municipal aid center.

Medical treatment

Medicine has no central place in the treatment of stress incontinence. Previously printed doctors often hormone estrogen, which could be used either locally in the vagina or as tablets. Recent studies show that it is doubtful whether estrogen helps. This treatment is therefore used less and less.

A new composition, duloxetine, have shown good effect in stress incontinence. A combination of duloxetine and PFMT can provide treatments more effective than separately.

Surgery

Surgery is better and more lasting results than other treatment. But surgery also has complications. Many methods are described, but only three are currently present, namely

• A tape during middle part of the urethra (tensionsfri vaginaltape, TVT)
• Injecting the bulking material around the urethra (periurethral injection)
• Conventional surgery (colposuspension)

TVT- surgery  is currently the most widely used surgical treatment of stress incontinence. It is the method of choice for about 90% of cases. A ribbon is brought up behind the pubic bone through a small incision in the anterior vaginal wall and placed loosely under the middle part of the urethra.

The procedure is usually performed under local anesthesia, and you can go home the same day. This method works well, and is also suitable for the elderly. Compared with the larger intervention (colposuspension) couriers TVT least as many patients. The procedure is simpler, has fewer complications and shorter convalescence.

PTT is an interference much like the TVT, which has the same effect as TVT.

How is long-term prospects?

Stress incontinence is a problem that often increases with age. With proper use and utilization of the available treatment methods, it is possible to cure or ameliorate the condition of the majority.

How do I avoid or aggravate stress incontinence?

One can prevent and treat stress incontinence by exercises to strengthen the pelvic floor, optionally combined with lifestyle changes as indicated above.