Stress Urinary Incontinence

INTRODUCTION:

Stress incontinence is the frequent early post partum problem. Urinary incontinence (UI) is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life.

It is loss of small amounts of urine with coughing, laughing, sneezing, exercising or other movements that increase intraabdominal pressure and thus increase pressure on the bladder. Physical changes resulting from pregnancy, childbirth, and menopause often cause stress incontinence, and in men it is a common problem following a prostatectomy. It is the most common form of incontinence in men and is treatable.

CAUSES:

  • Stress urinary incontinence (SUI) is essentially due to pelvic floor muscle weakness.
  • The urethra is supported by fascia of the pelvic floor. If the fascial support is weakened, as it can be in pregnancy and childbirth, the urethra can move downward at times of increased abdominal pressure, resulting in stress incontinence.
  • Stress incontinence can worsen during the week before the menstrual period. At that time, lowered estrogen levels may lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause, similarly because of lowered estrogen levels

DIAGNOSIS:

Patients with incontinence should be referred to a medical practitioner specializing in this field. Urologists specialize in the urinary tract, and some urologists further specialize in the female urinary tract. A urogynecologist is a gynecologist who has special training in urological problems in women. Gynecologists and obstetricians specialize in the female reproductive tract and childbirth and some also treat urinary incontinence in women. Family practitioners and internists see patients for all kinds of complaints and can refer patients on to the relevant specialists.

A careful history taking is essential especially in the pattern of voiding and urine leakage as it suggests the type of incontinence faced. Other important points include straining and discomfort, use of drugs, recent surgery, and illness.

The physical examination will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.

A test often performed is the measurement of bladder capacity and residual urine for evidence of poorly functioning bladder muscles.

Other tests include:

  • Stress test – the patient relaxes, then coughs vigorously as the doctor watches for loss of urine.
  • Urinalysis – urine is tested for evidence of infection, urinary stones, or other contributing causes.
  • Blood tests – blood is taken, sent to a laboratory, and examined for substances related to causes of incontinence.
  • Ultrasound – sound waves are used to visualize the kidneys, ureters, bladder, and urethra.
  • Cystoscopy – a thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder.
  • Urodynamics – various techniques measure pressure in the bladder and the flow of urine.

Patients are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, noting times and the amounts of urine produced.

TREATMENT:

PHYSIOLINE’S SPECIALIZED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY

At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

  • Exercises
  • Vaginal cone therapy
  • Electrical stimulation
  • Biofeedback
  • Timed voiding or bladder training
  • Medications
  • Slings
  • Adjustable sling

OTHER PROCEDURE:

  • Surgery
  • Bladder repositioning
  • Marshall-Marchetti-Krantz
  • Bladder augmentation
  • Artificial urinary sphincter
  • Catheterization

Visit Physioline for the Consultation and treatment