What are the other Names for this Condition? (Also known as/Synonyms)

• Effort Incontinence
• Stress Urinary Incontinence (SUI)
• SUI (Stress Urinary Incontinence)

What is Stress Incontinence? (Definition/Background Information)

• Stress Incontinence is characterized by the involuntary, unexpected leakage of urine when extra pressure is exerted within the abdomen and on the bladder during bouts of coughing, exercising, laughing, or sneezing
• The cause of Stress Incontinence is weakening of sphincter and detrusor muscles in the bladder, which control the urine from leaking and keeping the bladder in a relaxed state, respectively. The condition is also known as Stress Urinary Incontinence (SUI)
• Although different types of incontinence are known, Stress Incontinence is the most prevalent type observed. But, it is also important to note that Stress Incontinence is not caused by emotional or psychological stress
• The condition affects individuals of middle age or older age groups; the incidence being generally higher in women. Advancing age, surgery in the pelvic region, prolonged constipation, and obesity are some risk factors. In women, prolonged labor, multiple vaginal deliveries, and pelvic prolapses are additional risk factors for Stress Incontinence
• The major symptoms of Stress Incontinence include unexpected leaking of urine during laughing, coughing, sneezing, or even running (exercising). Some potential complications include urinary tract infections, fistulae, unpleasant odor, irritation of vaginal lips in women, abscess formation, and pain during intercourse
• In order to diagnose Stress Incontinence, a healthcare professional may employ a pelvic (in women) or genital (in men) examination, check the strength of the bladder and pelvic muscles, undertake a post-void residual test, imaging studies of the pelvic area organs, and conduct a urine flow test
• The treatment options for Stress Incontinence may vary from one individual to another. Behavioral changes, such as frequenting the restroom and limiting/regulating fluid intake, and pelvic floor exercises to strengthen the muscles can help those affected. In cases where the exact cause is known, and the condition may be corrected surgically, surgery may be an option
• Stress Incontinence may not be cured through Kegel exercises, behavioral changes, and/or medication, although these may help relieve symptoms. Surgical repair can lead to a cure, but the outcome is often dictated by an individual’s overall health, and if there are other underlying genital or urinary conditions

Who gets Stress Incontinence? (Age and Sex Distribution)

• Stress Incontinence is generally observed in middle-aged and older adults
• Even though both male and female genders are affected, the condition is more common in females with a female-male ratio of 2:1
• Individuals of all races and ethnicity are at risk for the condition

What are the Risk Factors for Stress Incontinence? (Predisposing Factors)

The following are some risk factors associated with Stress Incontinence:

• Age: With advancing age, weakening of the pelvic region muscles is a possibility
• Childbirth: A prolonged labor, multiple vaginal deliveries, and forceps delivery, are all risk factors in women
• Obesity: Excess weight puts excess pressure on the urinary bladder 
• History of pelvic surgery: Hysterectomy in women and prostate cancer surgery in men
• Pelvic prolapse in women; the bladder, urethra, and rectum wall extend out into the vagina
• Hormone deficiency, such as estrogen deficiency
• Chronic cough
• Prolonged high-impact activities
• Smoking
• Drinking alcohol or caffeine drinks in excess

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Stress incontinence? (Etiology)

Stress Incontinence is caused by damage to or weakening of the muscles in the pelvic floor and urinary bladder.

• Generally, urination is controlled by co-ordination between urinary tract and the nervous system. The flow of urine is controlled by two muscles:
  • Sphincter muscle, which contracts to control the urine from leaking, and the detrusor muscle of the bladder wall, which is always in a relaxed position for the bladder to expand
  • When the above two muscles are weak or if they are not functioning properly, the sphincter cannot prevent urine from leaking out when pressure is exerted on the bladder, causing Stress Incontinence

Damage to or weakening of the muscles in the pelvic floor and the urethral sphincter may be due to the following factors:

• In women:
  • Pregnancy with weight gain and hormonal changes 
  • Increased number of vaginal childbirth, forceps used during childbirth, prolonged labor
  • Muscle tearing during childbirth
  • Episiotomies wherein the muscle is cut open to make childbirth easier
  • Menopause during which the estrogen is less in the body, which can weaken the pelvic floor and the urethral sphincter
  • Hysterectomy 
  • Bladder surgeries
• In men: Prostate surgery
• In both men and women:
  • Chronic constipation
  • Health conditions or habits that cause chronic cough
  • Weakening of muscles due to advancing age
  • Being overweight or obese
  • Injury to the urethra

What are the Signs and Symptoms of Stress incontinence?

The signs and symptoms of Stress Incontinence include the involuntary leakage of urine during activities such as:

• Coughing
• Exercising
• Sneezing
• Running
• Laughing
• Lifting heavy objects
• Having sexual intercourse

How is Stress incontinence Diagnosed?

Stress Incontinence may be diagnosed using the following tests and exams as determined by a healthcare professional:

• A thorough physical examination including:
  • Pelvic examination in women, which may reveal the urinary bladder and urethra extending into the vagina
  • Genital examination for men
  • Rectal examination
• The following tests may be performed:
• Electromyogram (EMG) to check the activities of the muscles in the urethra or pelvic floor
• Pad test: A sanitary pad is placed and the individual is asked to exercise. After the exercise, the pad is checked to find how much urine has leaked into it
• Pelvic and abdominal ultrasound
• Post void residual test (PVR)
• Urodynamic studies for measuring the pressure and the flow of urine
• Cystoscopy to view the inside portion of the urinary bladder
• Urinalysis and urine culture
• Urinary stress test, where the patient is asked to cough with a full bladder
• X-rays of the kidneys and bladder

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Stress incontinence?

The potential complications from Stress Incontinence may include:

• Fistulas: An abnormal connection between an organ, vessel, or intestine
• Abscess formation (tissue infection with pus formation)
• Vaginal discharge; irritation of the vaginal lips
• Frequent urinary tract infections (recurrent UTIs)
• Extreme pain during intercourse, known as dyspareunia
• Undesirable/bad odors from the genital region
• Emotional stress due to embarrassment
• Limiting social life leading to social isolation

How is Stress incontinence Treated?

The treatment options for Stress Incontinence vary, depending on the severity of symptoms. They may involve the following measures:

• Behavior changes are often used for mild signs and symptoms:
• Decreasing the amount of fluid intake
• Increasing restroom trips to urinate
• Avoiding or minimizing physical activities suspected to cause the condition 
• Eating a diet rich in fiber
• Use of laxatives to avoid constipation
• Smoking cessation to reduce coughing and subsequent irritation to the lungs
• Restricting the intake of alcohol and caffeine drinks 
• Obese individuals may be advised to lose weight 
• Avoiding spicy foods and carbonated drinks
• Good glycemic control in diabetes
• Pelvic floor muscle training:
• Kegel exercises to strengthen muscles involved in control of the bladder
• Use of vaginal cone in women
• Electrical stimulation therapy, which uses low-voltage electric current to activate and contract the pelvic floor muscles
• Administration of medications such as anticholinergic drugs, alpha-adrenergic agonist drugs and antidepressants

Surgery may be recommended when the cause of Stress Incontinence is known. Surgical procedures are usually effective, unless the following are noted in the affected individuals:

• Have an underlying condition that makes surgery difficult
• If there are other genital or urinary problems
• Having already undergone surgery that has failed to bring about a cure

Some of the invasive measures may include:

• Anterior vaginal repair or para-vaginal repair in women, when the bladder extends into the vagina
• In men, implantation of artificial urinary sphincter
• Collagen injections to help thicken the area around the urethra
• Slings for men
• Retro-pubic suspensions to lift the bladder and urethra
• Tension-free vaginal tape to cinch the urethra
• Vaginal sling to support the urethra

How can Stress incontinence be Prevented?

Preventive measures to reduce the risk of Stress Incontinence are:

• Kegel exercises to tighten the pelvic floor muscles
• Kegel exercises during and after pregnancy 
• Avoiding risk factors such as smoking, alcohol abuse, or excess caffeine intake
• Avoiding constipation through a fiber-rich diet; use of laxatives when necessary

What is the Prognosis of Stress incontinence? (Outcomes/Resolutions)

The prognosis of Stress Incontinence depends on the severity of the signs and symptoms, response to treatment measures, and the overall health of the individual.

• In individuals with mild signs and symptoms, the prognosis is excellent
• Also, individuals showing a good response to surgery, the prognosis is excellent

In general, Stress Incontinence is manageable through suitable pelvic floor exercises, medications, and lifestyle modifications. However, these can only reduce the severity of symptoms and may not completely cure the condition.

Additional and Relevant Useful Information for Stress incontinence:

Stress Incontinence should not be confused with urge incontinence

• In urge incontinence, there is unintentional loss of urine due to muscles of urinary bladder contracting
• There is also an urge to urinate, which does not happen in Stress Incontinence

Also, Stress Incontinence should not be confused with an overactive bladder, which is a urological condition that results in a sudden frequent urge to urinate, resulting in the involuntary spillage of urine.

The following DoveMed website link is a useful resource for additional information:

http://www.dovemed.com/healthy-living/womens-health/