Stress urinary incontinence – severity, causes, treatment

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Stress urinary incontinence is the involuntary leakage of urine due to exercise or coughing. The reason may be excessive mobility of the area where the bladder connects with the urethra under load due to insufficient support against the pelvic floor. The failure of the internal urethral sphincter muscle also contributes to the development of ailments.

1. Urinary incontinence affects many people, significantly reducing their quality of life
2. Women are primarily exposed to the disease, especially those who have had childbirth behind them
3. The cause of stress urinary incontinence can also be some diseases, including, for example, chronic lung disease
4. More current information can be found on the Onet homepage.

What is stress urinary incontinence?

Stress urinary incontinence is a condition the main cause of which is a disturbed mechanism of urethral closure. The discomfort occurs when performing activities that lead to an increase in pressure in the abdomen, such as coughing, exercising or sneezing. These activities cause the abdominal pressing mechanism to start. Ailments in the form of excessive urethral mobility and insufficiency of the sphincter mechanism prevent the pressure from developing higher than that in the abdominal cavity, which is needed to keep urine in the bladder. According to the WHO (World Health Organization), the problem of urinary incontinence is very widespread. According to studies, stress urinary incontinence accounts for almost half of all incontinence cases. This embarrassing ailment is much more common in women than in men, and increases with age. Although stress urinary incontinence is considered a problem for older women, it can also affect younger girls.

Stress urinary incontinence is characterized by:

1. lack of urge to urinate,
2. high intra-abdominal pressure causing urine to leak out involuntarily
3. lack of detrusor muscle contraction.

Stress urinary incontinence – causes

Stress urinary incontinence is a condition that may be caused by too much mobility in the area where the bladder meets the urethra under load due to insufficient support against the pelvic floor. As is the failure of the muscle of the internal urethral sphincter. Stress urinary incontinence due to inadequate support under stress can occur with or without lowering the anterior vaginal wall. Vaginal lowering is not a direct cause of urinary incontinence.

Both defects often have the same cause, i.e. pelvic floor weakness. It occurs due to the stretching and denervation of the pelvic floor muscles after childbirth due to the atrophy of these muscles, as well as individual weakness of the connective tissue. In the postmenopausal period, estrogen deficiency can impair the tightness of the urethra. Direct injuries of the urethra cause scarring, which in turn disrupts its function.

The factors predisposing to stress urinary incontinence are:

1. number of births: more than two,
2. natural childbirth,
3. overweight or obesity,
4. childbirth after 42 weeks of pregnancy,
5. operations performed in the area of ​​the lower abdomen,
6. oxytocin-induced labor
7. having a child weighing more than 4000 g,
8. childbirth lasting more than 24 hours,
9. Ehlers-Danlos syndrome,
10. smoking,
11. diabetic neuropathy,
12. stroke,
13. constipation
14. chronic lung disease.

On the other hand, in men, stress urinary incontinence is associated with damage (as a result of surgery) of the mechanism responsible for urinary incontinence. Procedures that increase the risk of this disease include surgery to remove the prostate adenoma and radical prostatectomy. Stress urinary incontinence can also be caused by birth defects and mechanical damage to the pelvis.

Stress urinary incontinence – grades of severity

There are three degrees of severity of stress urinary incontinence:

1. stage I – leaking urine only as a result of strenuous effort (e.g. lifting heavy objects, coughing),
2. grade II – urinary incontinence due to light physical activities, such as getting up or walking,
3. stage III – urinary incontinence, also in the supine position.

symptoms

Stress urinary incontinence may be accompanied by an unpleasant urge to urinate and frequent urination in small amounts. The symptoms of this type of urinary incontinence are especially intense during the day. Symptoms of stress urinary incontinence are aggravated by obesity, chronic cough, chronic urinary tract infection, shortness of breath (e.g. in cigarette smokers).

How is stress urinary incontinence diagnosed?

The diagnosis of stress urinary incontinence in most patients is possible with the help of a medical history examination. A very detailed medical history allows you to make a correct diagnosis. Diagnostic tests depend on the severity of this ailment. Most of the patients who come to the doctor with this embarrassing problem are women who have had several births.

Diagnostics of stress urinary incontinence include:

1. urine culture test,
2. residual urine test,
3. general urine test
4. performing provocation tests, e.g. cough test for urinary incontinence,
5. examination through the vagina with a speculum,
6. radiological examination using contrast (urethrocystography, urography),
7. urethrocystoscopy.

The basis is a gynecological examination, thanks to which it is possible to accurately assess the vulva and perineum in women. During the examination, the doctor may ask the patient to cough, thanks to which he can check the opening of the urethra and the anterior vaginal wall after insertion of the speculum. Very often, when coughing, involuntary urination occurs. In addition, the Bonney-Marchetti test is performed, which involves inserting the fingers into the vagina and then lifting its front wall (without compressing the urethra).

The basic diagnostic methods should belong to urodynamic studiesthanks to which it is possible to evaluate changes in bladder tone, contractile activity and tubular flow. The equipment used to measure these parameters is very complicated and expensive.

It is also helpful in the diagnosis of stress urinary incontinence stick test, which allows to show excessive mobility of the neck, blisters and the nearby section of the urethra. During the examination, a cotton swab is inserted into the urethra, and then the change in the angle of inclination is observed during the Valsalva maneuver. If the change in angle is more than 30 degrees – we can talk about excessive mobility of the urethra.

It is also important to differentiate stress urinary incontinence from other ailments. In the differential diagnosis, neurological examinations are performed to rule out endocrine diseases such as diabetes and diabetes insipidus. Sometimes, MRI can help.

Treatment of stress urinary incontinence

In the treatment of stress urinary incontinence, she uses conservative, surgical and less invasive – laser methods. Conservative treatment is implemented first.

1. Physical therapy. This method of treatment is used when urinary incontinence is not severe. It works by exercising the pelvic floor muscles by clenching your buttocks and thighs and retaining urine while you urinate. Another exercise is to pinch your vagina on “your two fingers.” There are also special cones on the market that must be periodically inserted into the vagina, and they are kept in it by tightening the muscles of the perineum. At Medonet Market you can now buy pessaries that are used to treat urinary incontinence. Biofeedback is also an exercise used on the pelvic floor muscles. Bladder exercise should be the first step in the treatment of detrusor disorders.

Pharmacological treatment. Pharmacological preparations are used when the urinary detrusor muscle is unstable. Then the surgical treatment does not bring the expected result. Treatment in menopausal women mainly involves hormone therapy. Thanks to the vaginal use of estrogens, the epithelium of the vagina, vulva and the lower part of the urethra and the bladder neck can be partially regenerated. However, the effectiveness of estrogens is modest, they are only of importance in the treatment of urinary tract infections, atrophic changes of the vulva and urge to urinate.

Surgical treatment. The indication for this type of treatment is recurrent stress urinary incontinence and the lack of effects after the use of conservative and pharmacological treatment. The operation is aimed at improving the anatomical structure of the pelvic organs and at the reconstruction of the posterior vesicourethral angle.

There are 3 types of operations, each of which has many variations:

1. vaginoplasty of the urethra (unfortunately not very effective).
2. surgeries fixing the urethra from the access above the pubic symphysis (Marschal-Marchetti-Krantz operation, Burch operation, Stamey operation).
3. suspension operations using loops made of own tissues or artificial materials (Moira, Aldrige, TVT, IVS surgery).

Stress urinary incontinence – laser therapy

An innovative method that is relatively safe is laser treatment of stress urinary incontinence. It is intended mainly for women who have a problem with urinary incontinence. The laser method involves inserting a laser beam into the vagina, which is directed towards the anterior wall and the opening of the bladder and the atrium. The bundles constrict the vaginal walls and stimulate the growth of collagen fibers of the mucosa, which make the vagina supple. The procedure is performed with the Dualis SP erbium-yag laser by Fotona, and the method is called IncontiLase. This method is very effective (it reduces the angle of inclination of the urethra, among other things) in the treatment of stress urinary incontinence, as evidenced by the award it won in the Best Aesthetic Medicine Treatment category in the “Prix de beaute Cosmopolitan 2013” competition.

Another type of this method is the MonaLisa Touch laser. Its action strengthens the vaginal walls and the intra-pelvic fascia and the opening of the urethra. In addition, the action of the laser beams stimulates the production of glycogen, which is of great importance in moisturizing the vagina and its proper PH.

Laser therapy can be used in any of the three stages of stress urinary incontinence. It is especially recommended for women who are incontinent due to multiple births and congenital defects in connective tissue. In turn, the contraindications to the use of this method are:

1. breast-feeding,
2. epilepsy,
3. pregnancy,
4. bad results of pap smear tests,
5. tumor,
6. menstruation,
7. diabetes (unregulated),
8. taking anticoagulants,
9. taking preparations: sedatives, photosensitive, diuretics, antiepileptics, and quinolone antibiotics and cystostatic drugs,
10. inflammation of the genital tract,
11. autoimmune diseases.

Note: Laser therapy should be carried out by an experienced gynecologist or urologist. Detailed knowledge of the anatomy of the reproductive organ is very important.

After the procedure, the patient can return to normal daily activities. However, it is recommended to wear pads for a few days after the procedure, as vaginal exudates may appear, which will subside over time. During recovery, it is very important to refrain from sexual intercourse for about 2-4 weeks. In addition, women should limit their physical exertion and not overburden themselves.