Stress incontinence: causes, effects and treatment

Stress incontinence: causes, effects and treatment

Stress incontinence is a common form of urinary incontinence, characterized by involuntary loss of urine during physical exertion or pressure on the bladder. This type of incontinence primarily affects women but can also affect men, particularly after prostate surgery. This section describes the causes, effects, and treatment options for stress incontinence.

Causes of stress incontinence

1. Weakening of the pelvic floor muscles:

   • Pregnancy and childbirth: The stretching and strain on the pelvic floor muscles during pregnancy and vaginal births can lead to weakening of these muscles.
   • Hormonal changes: Especially after menopause, a decline in estrogen levels leads to a weakening of the pelvic floor and connective tissue.

2. Damage to the sphincter muscles:

   • Surgical procedures: Pelvic surgeries, such as hysterectomies or prostate surgery, can damage the sphincter muscles and surrounding structures.
   • Injuries: Trauma or accidents affecting the pelvic floor can damage the muscles and nerves.

3. Increased abdominal pressure:

   • Obesity: Excessive body weight puts additional pressure on the bladder and pelvic floor.
   • Chronic cough: Conditions such as chronic bronchitis or smoker's cough increase intra-abdominal pressure.
   • Heavy lifting: Regularly lifting heavy objects can increase pressure on the bladder and pelvic floor.

4. Genetic predisposition:

   • Some people have a congenital weakness of the connective tissue, which can increase the risk of stress incontinence.

Effects of stress incontinence

1. Social and emotional impacts:

   • Shame and embarrassment: Uncontrolled urinary loss can lead to feelings of shame and social isolation.
   • Reduced self-esteem: Those affected often feel less confident and attractive.

2. Physical effects:

   • Skin irritations: Constant contact with urine can lead to skin irritations and infections.
   • Limited activity: Those affected avoid physical activity for fear of urine loss.

3. Professional and economic impacts:

   • Reduced ability to work: Frequent changes of clothing and hygiene products can impair productivity in the workplace.
   • Cost pressure: Expenses for incontinence products and possible medical treatments can be financially burdensome.

Treatment options for stress incontinence

1. Conservative treatment:

   • Pelvic floor training (Kegel exercises):
     • Description: Regularly tensing and relaxing the pelvic floor muscles strengthens these muscles.
     • Benefits: Can improve bladder and sphincter control and reduce the symptoms of incontinence.
   • Bladder training:
     • Description: Targeted training to extend the time intervals between toilet visits.
     • Benefits: Helps increase bladder capacity and better control urination.
   • Weight reduction:
     • Description: Weight loss reduces pressure on the bladder and pelvic floor.
     • Benefits: Can significantly improve the symptoms of stress incontinence.

2. Drug treatment:

   • Topical estrogens:
     • Description: Local application of estrogen creams or suppositories strengthens the tissue of the urethra and pelvic floor.
     • Advantages: Particularly effective in postmenopausal women.
   • Duloxetine:
     • Description: An antidepressant that increases the activity of the anal sphincter.
     • Benefits: Can improve control over urination.

3. Pessaries:

   • Description: Vaginally inserted devices that support the urethra and reduce pressure on the bladder outlet.
   • Advantages: Non-surgical option that often provides immediate relief.

4. Surgical treatment:

   • Sling operations (TVT, TOT):
     • Description: A mesh band is placed under the urethra to support it and prevent urine from leaking out.
     • Advantages: High success rate and long-term improvement of symptoms.
   • Colposuspension:
     • Description: A surgical procedure in which the bladder and urethra are elevated to support the bladder outlet.
     • Advantages: Particularly effective for severe incontinence.
   • Injection of bulking agents:
     • Description: Injection of substances around the urethra to thicken it and increase the closure pressure.
     • Advantages: Minimally invasive procedure with relatively short recovery time.

Preventive measures

1. Regular exercise: Pelvic floor exercises should be incorporated into your daily fitness routine to maintain and improve muscle strength.
2. Avoiding excess weight: A healthy body weight reduces pressure on the bladder and pelvic floor.
3. Cough management: Chronic cough should be treated to reduce pressure on the pelvic floor.
4. Diet: A diet rich in fiber helps prevent constipation, which reduces pressure on the pelvic floor muscles.

conclusion

Stress incontinence is a common form of incontinence, primarily caused by weakening of the pelvic floor muscles and increased abdominal pressure. A combination of conservative measures, medication, and surgical interventions can improve control over urinary flow and significantly improve the quality of life of those affected. Preventive measures are also important to reduce the risk of stress incontinence and maintain long-term bladder function.