Stress incontinence is one of the most common forms of incontinence and it’s estimated that three million people in the UK are affected although this number may be conservative because some won’t mention it to their doctors. It also becomes more common in women as they age and go through the menopause. Estimates suggest that 1 in 5 women over 40 may suffer some degree of stress incontinence.
As we eat and drink the kidneys produce urine which passes through the ureter tubes to the bladder. The amount we eat and drink influences the amount of urine that is made. As the bladder fills with urine it swells until we feel a need to go to the toilet. When we do go the outlet from the bladder opens and the pelvic floor muscles relax allowing urine to pass through the urethra.
Stress incontinence refers to the leakage of urine that occurs when there is unexpected pressure on the bladder caused by coughing, exercising or even sneezing. It happens because the pelvic floor muscles are weakened through childbirth, obesity or even some treatments for cancer. The pelvic floor muscles are found around the base of the bladder and rectum.
The most common treatment option is with regular use of the kegel exercises, also known as pelvic floor exercises. These exercises help to strengthen the core abdominal muscles. Pilates and yoga also help to strengthen these muscles. For those who are overweight then losing weight can help in conjunction with exercise. Smokers can also exacerbate their symptoms so giving up would be advisable. Finally, going to the loo when you feel a need means that the bladder is not put under undue strain and can reduce the number of leakages considerably. Drug treatments or surgery can also be offered if necessary.
Complimentary therapies include using devices to create electrical stimulation with the aim of stimulating the pelvic floor muscles to become stronger. Weighted vaginal cones can also be used to train the muscles to work more effectively. Biofeedback is a technique that helps your body to learn when the right muscles have been contracted by emitting a tone from the computer.
Drug treatments include Duloxetine which is usually used to treat depression. It is believed to interfere with the chemical messaging that sends impulses to the pelvic floor muscles helping them to become stronger. In one study 60% of the women who took Duloxetine had 50% fewer urine leakages than before.
There are also a number of different surgical treatments that can be used when pelvic floor muscle exercises have not helped. All of them aim is to tighten or support the muscles underneath the bladder.
The tension-free vaginal tape (TVT) is a procedure often used to treat stress incontinence. It involves the use of tapes to support the pelvic floor muscles. There are mixed feelings amongst women about whether it is successful or not. In some cases women have had the tapes removed in further operations. Some women have had to have it removed due to problems it has caused.
Colposuspension is an operation in which the top of the vagina is lifted up and the surgeon uses stitches to tie it behind the pubic bone (the bone behind your pubic hair). The stitches left in place permanently.
An alternative semi-surgical procedure is the use of a bulking agent which is injected into the bladder entrance, to keep it closed. These injections may be either natural materials (such as fat) or synthetic ones (such as silicone).