Stress Incontinence

General Illness Information

Medical Term:
INCONTINENCE, STRESS

Common Name: None Specified

Description:

Involuntary loss of bladder control and passage of urine in conditions of high abdominal pressure or stress (coughing, sneezing, lifting, etc.).

Commonest in post-menopausal women.

Causes:

  • Loss of pelvic support with age, childbirth and surgery.
  • Damage to sphincter control mechanisms in males (rare).

Prevention:

  • Eat a normal, well-balanced diet and exercise regularly to build and maintain muscle strength.
  • Regular physical exams in males and females to detect any early problems.
  • Females can learn and practice Kegel exercises after childbirth.

Kegel exercises:

Females can learn to recognize, control and develop the muscles of the pelvic floor. These are the ones you use to interrupt urination in mid-stream. The following exercises strengthen these muscles so you can control or relax them completely:

To identify which muscles are involved, alternately start and stop urinating when using the toilet.

Practice tightening and releasing the muscles while sitting, standing, walking, driving, watching TV or listening to music.

Tighten the muscles a small amount at a time, “like an elevator going up to the 9th floor”. Then release very slowly, “one floor at a time”.

Tighten the muscles from front to back, including the anus, as in the previous exercises.

Practice exercises every morning, afternoon and evening. Start with 5 times each, and gradually work up to 20 or 30 each time.

Signs & Symptoms

Loss of control of bladder function during periods of increased intra-abdominal pressure. This results in unintentional loss of urine with lifting, sneezing, singing, coughing, laughing, crying or straining to have a bowel movement. This may progress to the point where the patient is afraid to venture outdoors or to socialize.

Risk Factors

  • Repeated childbirth.
  • Adults over 60.
  • Obesity.
  • Chronic cough.
  • Surgery, cancer or radiation damage to the sphincter mechanism in males.

Diagnosis & Treatment

The diagnosis is usually made by the history.

General Measures:

  • Pelvic floor exercises (Kegel’s exercises).
  • Good perineal hygiene.
  • Incontinence pads
  • Frequent emptying of the bladder.

Medications:

  • Antibiotics for any inter-current urinary-tract infection.
  • Sympathomimetic drug therapy, which helps increase the tone of urethral muscles, may be prescribed.
  • Estrogen therapy may be prescribed.

Activity:

No restrictions.

Diet:

  • Lose weight if you are overweight.
  • Decrease amount of caffeine and alcohol in your diet.
  • Avoid high volume of fluid intake in situations where access to bathroom facilities is limited (airplane trips).

Possible Complications :

  • Complete loss of urinary control. This requires surgery.
  • Urinary-tract infections (recurrent).
  • Social isolation as mentioned above.

Prognosis

If the stress incontinence is not severe enough to require surgery, exercise can improve the muscle function. If it is severe, it can be cured with surgery.

Other

‘Nothing Specified’.

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