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Stress incontinence

Stress incontinence happens when the urethra can't hold back the pressure of urine in the bladder. Leakage can happen triggered by things like coughing or sneezing.

Stress incontinence is one of the most common types of incontinence in women.

What causes stress incontinence?

With stress incontinence, movements and activities such as coughing, sneezing and lifting put greater abdominal pressure on the bladder. That causes the leakage of urine.

A number of things can contribute to stress incontinence. For instance, it can result from weak muscles in the pelvic floor or a weak sphincter muscle at the neck of the bladder. A problem with the way the sphincter muscle opens and closes can also result in stress incontinence.

Stress incontinence, especially in women, is often caused by physical changes to the body. Things that can cause these changes include:

  • Pregnancy and childbirth
  • Nerve damage during labour
  • Menopause
  • Surgery
  • Problems with muscles in the bladder -- the organ that holds urine -- and the urethra
  • Weakened muscles around the bladder

In cases of stress incontinence, the muscles in the pelvis can weaken. This can cause the bladder to drop down into a position that prevents the urethra from closing completely. The result is a leakage of urine.

What are the symptoms of stress incontinence?

The main symptom of stress incontinence is a leakage of urine at times of physical movement or activity. Examples of the kinds of activities associated with urine leaking include laughing, coughing, lifting or exercise. The leakage may be as little as a drop or two, or may be a "squirt" or even a stream of urine.

How is stress incontinence treated?

Self-help techniques and aids can be used to treat mild stress incontinence. In addition, there are a number of treatments available for stress incontinence:

Pelvic floor exercises: Pelvic floor exercises, also called Kegel exercises, help strengthen the muscles that support the bladder. By strengthening these muscles, you can reduce or prevent leakage problems.

Medication: A drug called duloxetine can be used to treat stress incontinence when conservative treatments have not worked, or when medication is preferred to surgery or surgery is not possible.

Injections: Bulking agents are substances that are injected into the lining of the urethra. They increase the size of the urethra lining and improve the closure mechanism of the neck of the bladder. Collagen is one bulking agent that is commonly used. If successful, periodic injections may be needed.

Surgery: When other methods for treating stress incontinence do not work, surgery may be an option. There are different types of operations designed to help keep the bladder in place and treat stress incontinence:

  • Colposuspension: In this procedure, the surgeon makes an incision in the abdomen. The surgeon then attaches the neck of the bladder to cartilage behind pubic bone with sutures ( stitches).
  • Tape procedure: A piece of tape is inserted through the vagina and threaded behind the urethra to support the urethra.
  • Sling procedure: In this procedure, the surgeon uses a sling made of either natural (human) tissue or synthetic material. The sling goes around the bladder neck supporting it. The sling may be attached to the pubic bone or to two sutures that are loosely attached to each other.
  • Artificial sphincters: Most frequently used for men but also may be appropriate for women. A fluid-filled cuff is implanted around the urethra that can be opened and closed by the patient and that serves as a valve to contain the bladder content that might otherwise leak.

These procedures can effectively treat the vast majority of stress incontinence cases. Possible side effects of surgery include continued or worsened incontinence or an inability to urinate.

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WebMD Medical Reference

Medically Reviewed by Dr Rob Hicks on October 23, 2014

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