Treatment of Stress Urinary Incontinence

Treatment of Stress Urinary Incontinence
Stress urinary incontinence is a common problem that plague women, especially after childbearing. It is the involuntary leakage of urine that occurs with coughing, sneezing, laughing or other events that increases the abdominal pressure. The severity can range from the occasional loss of a few drops to multiple leakage episodes a day requiring the use of multiple incontinence pads.

The majority of women will have mild symptoms and can take advantage of conservative treatment options. Depending on the severity of the symptoms, a woman can initiate some of this on her own or undergo an evaluation by a qualified provider to confirm the diagnosis.

The initial evaluation will consist of a thorough history and physical examination which should include a pelvic examination and an assessment of pelvic muscle strength. It is important to have a urinalysis and a urine culture as conditions such as a urinary tract infection can present with leakage. More detailed testing such as the completion of a bladder diary, assessment of postvoid urine residual and urodynamics may be recommended. These can help to distinguish between the different types of incontinence, determine the severity of the problem and help the doctor make appropriate treatment recommendations.

Behavioral therapy and physiotherapy are the most common suggestions. Behavioral therapy involves developing coping mechanisms and minimizing opportunities for leakage. Examples include pre-urge voiding to avoid developing urgency or voiding before exercise to keep the bladder volume low since some women will only leak with a full bladder. Weight loss is another method. Women who are obese and overweight may note a significant improvement in their leakage as they lose body fat.

Physiotherapy involves strengthening the muscles of the pelvic floor. This entails doing the traditional kegel exercises which involves squeezing the pelvic floor muscles and holding the squeeze for a set period of time and doing a certain number per day. Like lifting weights the muscles become stronger over time with increased repetition and endurance. Sometimes the exercises are not easy to perform and electrical stimulation and/or biofeedback helps with identifying, isolating and activating the muscles. Pelvic muscles exercises are about 50-60% effective in the treatment of stress urinary incontinence

Devices such as pessaries and urethra plugs have been utilized to prevent leakage. They essentially obstruct the urethra, preventing urine from passing during stressful events. These are not widely popular due to the inconvenience and discomfort of inserting and wearing a device but maybe valuable in certain select situation such as use during exercise only. Medications have been researched for stress incontinence and currently only Duloxetine has been shown to provide some degree of improvement. There are challenges with this medication including limited availability of the drug.
Conservative therapy should be considered for the management of stress urinary incontinence, especially in women who have mild symptoms. Surgery is certainly much more effective but has its risks which can only be justified in women whose symptoms are negatively impacting their life.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!


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