Stress Urinary Incontinence: Causes and Diagnosis
Overview
Stress urinary incontinence (SUI) is a leakage of urine during moments of physical activity that increases abdominal pressure. It may happen when a person coughs, lifts something heavy, changes positions, or exercise. SUI can also occur when the sphincter muscle that controls the urethra weakens.
SUI, as the most prevalent form of incontinence among women, affects an estimated 15 million adult women in the U.S. About 17% of women and 16% men over 18 years old have overactive bladder (OAB) and an estimated 12.2 million adults have urge incontinence.
Causes
Stress incontinence occurs when the muscles that control your ability to hold urine get weak or do not work. The most common causes of stress incontinence among women are pregnancy and childbirth. Among men, prostate surgery is a common cause of stress incontinence.
Some common causes include:
- Pregnancy and vaginal delivery
- Injury to the urethra area
- Some medicines
- Surgery in the pelvic area or the prostate (in men)
- Pelvic prolapse
- Older age
- Obesity
- Smoking
- Excessive urine production
- Caffeine intake
- Medications
- Hormonal deficiencies
Symptoms
The main symptom of stress incontinence is the loss of bladder control during physical activity. You may experience a few drops of urine or a large, involuntary flow. Leakage occurs without feeling the urge to urinate. This can happen while you are:
- Coughing
- Sneezing
- Laughing
- Lifting
- Getting out
- Doing exercises
- Having sexual intercourse
Because of the range in severity of SUI, there are many ways to evaluate and treat the condition.
Diagnosis
The doctor may give a diagnose after performing the following tests:
- Medical history
The doctor will ask the patient to describe the episodes of leakage, keep a bladder journal and talk about detailed medical history of incontinence symptoms.
- Physical examination
Following the detailed history, a physical examination of the urinary tract may help to understand specific reasons for the symptoms of incontinence.
- Diagnostic tests
The most commonly used tests include ultrasound, blood work, X-rays with contrast, urinary stress test, urinalysis, cystoscopy and urodynamic tests.
Treatment
Doctors often begin treatment by suggesting the least-invasive options. Patients experiencing minimal leakage may be comfortable wearing absorbent pads and avoiding invasive procedures. They may also be willing to make some lifestyle changes to lessen symptoms of SUI.
Behavior modifications
- Weight loss (for patients who are obese)
- Reducing caffeine intake
- Reducing alcohol intake
- Avoiding irritating substances, such as spicy food
- Avoiding strenuous activities
- Practicing Kegel exercises that strengthen the pelvic muscles
Medications for mild to moderate incontinence
- Anticholinergic drugs to control overactive bladder
- Antimuscarinic drugs to block bladder contractions
- Alpha-adrenergic agonist drugs to strengthen the sphincter
- Imipramine, a tricyclic antidepressant
Surgical options
- Threading surgical bladder slings under the urethra
- Creating an abdominal incision before stitching together the patient’s tissues
- Using a patient’s own tissues to reinforce the bladder wall
- Restoring weak or sagging vaginal walls
- Lifting the bladder and urethra
Keywords: stress urinary incontinence.
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