What is stress urinary incontinence?

 

Urinary incontinence is the involuntary leakage of urine.

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Stress urinary incontinence is when physical activity like coughing, running, laughing or lifting puts pressure on your bladder and this pressure causes you to leak urine.

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Stress urinary incontinence is very common.
Some women might feel embarrassed when they leak.
They might isolate themselves or stop doing activities they used to enjoy doing.
If you have stress urinary incontinence, treatment can really help your quality of life.

 

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How do I know if I have stress urinary incontinence?

 

If you have stress urinary incontinence, you might have leaking of urine when you:

• Laugh
• Cough
• Sneeze
• Stand up
• Lift something heavy

• Exercise
• Have sex

 

You might not leak every time you do one of these things. Sometimes it might be a small leak and other times it might be a lot. You should see a doctor if your symptoms start interfering and affecting your daily life (like your work, hobbies and social life).

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What causes stress urinary continence?

 

There are muscles that support your bladder and the urethra (a tube that carries the urine out of the body). These muscles control when you urinate. As your bladder fills up with urine, these muscles tighten to prevent you from leaking when you laugh, cough or run. When your bladder is full and you are in the bathroom, the muscles relax and you urinate normally.

 

If these muscles become weak they are not able to tighten properly your bladder is full. This is when you will leak urine. Your muscles might lose their strength for many different reasons. Most commonly, it is childbirth. Other factors might be age, chronic coughing from lung problems or smoking, obesity, and heavy lifting over many years.

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How do you test for stress urinary incontinence?

 

When you see your doctor, your doctor will get some information from you and may do a physical exam. Your doctor might ask you to cough or push down to see if you leak urine.

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Usually, other tests are not necessary to test the function of your bladder. Sometimes, if it is not clear if you have stress urinary incontinence or other causes of urinary incontinence, you doctor might order urodynamics testing. These are tests to determine how well your bladder is working.

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What is urodynamics testing?

 

Urodynamics testing can include:

• Measurement of post-void residual urine. This test measures how much urine is left behind in the bladder after you urinate. It tests your ability to empty your bladder completely. After you urinate, a thin tube called a catheter is passed into your bladder to drain the remaining urine. Sometime an ultrasound can be used to create a picture of your bladder to see how much urine is left in the bladder.

• Measurement of bladder pressures. This test measures how much pressure is in your bladder as it lls up and at what pressure it starts to leak. A small catheter is passed into your bladder a warm fluid is used to ll your bladder. This tube can measure the pressure in your bladder. A small tube will also be placed in the vagina to measure the pressure of your abdomen.

• Cystoscopy. This test allows your doctor to look at the inside of the bladder. A small thin telescope is inserted into the bladder and warm fluid is used to ll the bladder to let your doctor see.

 

 

I have stress urinary incontinence. What treatments can I have that don’t involve surgery?

Your doctor might recommend a combination of treatments. There are behavioral therapies to help decrease the number of episodes of incontinence. There are devices that help control incontinence and there are surgeries to help correct the weak muscles.

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Behavioral Therapies

• Pelvic floor muscle exercises. Your doctor or a pelvic oor physiotherapist can teach you how to use exercises, called Kegel exercises, to strengthen your muscles.

• Fluid consumption. Avoid ca einated drinks (like tea and co ee) and alcohol because these might irritate your bladder.

• Lifestyle changes. Quit smoking, losing weight and treating a cough can improve your symptoms

• Bladder re-training. Schedule your toileting regularly to avoid having a very full bladder.

   

Devices or Pessary

This is a special vaginal pessary that is shaped like a ring with a bump that pushes against the urethra and can help prevent leakage.

 

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I have stress urinary incontinence. What surgeries can I have?

 

Your doctor might recommend surgery to treat your symptoms. Ask your doctor about the details of surgery, risks of surgery and if it is a good option for you. Recovery from surgery takes 4 to 6 weeks. You should avoid sex, heavy lifting over 10 lbs and constipation for 6 weeks.

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Some women might have difficulties emptying their bladder and might have to go home with a catheter. A community nurse will go to your home or arrange for you to go to an outpatient centre in 4 to 7 days to take the catheter out and see if you can empty your bladder. Everyone will urinate eventually. Antibiotics will be given to you if you need a catheter.

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Transobturator Tape

This is a very common procedure performed for women with stress urinary incontinence. Your doctor will use a synthetic material (called polypropylene mesh) to create a sling or a hammock for your urethra to rest on. This supports the urethra as the bladder becomes full. The surgery is done vaginally – there are no cuts on the abdomen.

Laparoscopic Burch Urethropexy

This procedure is done by using 4 small cuts on the abdomen and putting a telescope through one of these cuts to let your surgeon see inside your abdomen. Using stitches, the tissue beside the urethra and the vagina is lifted up to a ligament beside the pelvic bones. By lifting these tissues, the urethra is better supported.

Laparoscopic Two-Team Sling

This procedure requires two surgeons, one that works up at the abdomen and the other works in the vagina.4 small cuts are made on the abdomen. Each end of a synthetic material is inserted either side of urethra from the vagina by the vaginal surgeon and is retrieved abdominally by the abdominal surgeon. The mesh is then stitched to ligaments beside the pelvic bones. This creates a hammock for your urethra to rest on. It can also help to repair any prolapse (or bulge) of the bladder into the vagina.

 

 

 

Sunnybrook Health Sciences Centre

2075 Bayview Avenue Toronto, ON M4N 3M5

Telephone: 416.480.6100

www.sunnybrook.ca
PR 47194 (MAR 2016)

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