Incontinence refers to the involuntary leakage of urine i.e., the person leaks urine unintentionally. In stress urinary incontinence, leakage occurs without intention during physical activities such as coughing, laughing or sneezing.
During activities such as coughing and sneezing the pressure within the abdomen (belly) rises. This squeezes the bladder, very much like squeezing a plastic bag containing water. The urinary bladder has a natural opening through which urine normally drains. This is guarded by a special muscle called sphincter and the pelvic floor muscles which prevent the urine from getting squeezed out unintentionally. However, if they are weak they cannot resist the force and urine tends to leak out when the abdominal pressure rises with acts such as coughing and sneezing.
Stress incontinence happens when the bladder and pelvic floor muscles become weak. The following conditions can cause weakening of the muscles
• Age- Several normal changes related to age in the urinary system can lead to stress incontinence
• Multiple child births can cause stretching, weakening and dysfunction of the pelvic floor muscles
• Chronic cough, constipation lead on to excessive strain on the pelvic floor. In the long run, this results in weakening of the pelvic floor.
• Urinary tract infection
Eliciting a focused history and examination by a good gynecologist is a must for the diagnosis of stress urinary incontinence. An ultrasound scan of the bladder is usually performed. Special urodynamic studies that allow us to study the flow of urine are helpful in the diagnosis. In addition, a urine analysis and culture are routinely performed to test for urinary infection
It is important to identify any of the factors that are leading on to stress incontinence. If you are taking some medicines that can precipitate incontinence, those need to be changed. We had listed obesity as a risk factor for stress incontinence. Weigh reduction through a combination of controlled diet and exercise is necessary in overweight people. Constipation or chronic cough, if present, must be corrected as they aggravate stress incontinence. A set of specialized exercises known as Kegel's exercise that are effective in improving the strength of the pelvic floor muscles are taught to people with stress incontinence. These exercises when performed regularly, gradually improve the muscles that control the bladder.
Sling surgery is however required for many women with stress incontinence. During a sling procedure, we use strips of a synthetic mesh or your own tissue to create a support for the neck of the urinary bladder. The bladder neck is the region through which urine drains out of the bladder. The sling supports this part of the bladder and helps to keep it closed during activities such as coughing or sneezing so that urine does not leak out. This surgery can be done laparoscopically so that post-operative pain is minimized and recovery is quicker.