Stress Urinary Incontinence: The Facts
Not being in control of your bladder and ‘accidental leakage’ can not only restrict your normal family life, but also be embarrassing and even depressing. Here, Obstetrician and Gynaecologist, Dr. Virginia Midrigan of Mediclinic Dubai Mall talks to us about the facts and treatments for stress urinary incontinence.
What is ‘stress urinary incontinence’ (SUI)?
Urinary incontinence is the loss of bladder control. The two most common types of urinary incontinence that affect women are stress incontinence and urge incontinence, also called overactive bladder. Stress urinary incontinence is an extremely common and distressing condition that affects a high percentage of women, with the chances of suffering from this increasing with age, as well as in pregnancy and after childbirth.
What causes the condition?
SUI involves involuntary leakage of urine due to increased internal pressure on the abdomen during activities such as coughing, sneezing, heavy lifting and physical activity. Urinary incontinence can either mean you leak a small amount of urine or release a lot of urine all at once when pressure is applied.
The risk factors for women developing stress urinary incontinence are:
- Increasing age, even though SUI can also occur in younger, active, healthy women
- Being overweight or obese
- Chronic cough
- Chronic constipation
- Chronic heavy lifting
- Nerve injuries /pelvic floor and bladder
How common is SUI and why are women more likely than men to be affected?
Stress urinary incontinence is twice as common in women than men and the numbers of people experiencing urinary incontinence increases as they become older. Pregnancy, childbirth and menopause also make urinary incontinence more likely. Having said that, urinary incontinence is not ‘just a normal part of ageing’ and in the vast majority of cases it can be treated in a pretty straightforward way.
How does SUI usually impact a woman’s life?
The main impact of SUI is on a person’s quality of life, as it can gradually erode a person’s confidence and result in them increasingly restricting many common daily activities to avoid leakage. Such avoidance might include taking children out to the park or on outings, visiting other people, going shopping, to the cinema etc.
While stress urinary incontinence is not a life-threatening condition, it is very important to ask for help if SUI restricts your ability to perform daily activities, limits your quality of life, stops you playing sports or causes other unwanted changes in your lifestyle. Patients who have incontinence are more likely to suffer from depression, have limited social contact and negative impacts on intimate relations, as well as feeling uncomfortable about their own own bodies. It is therefore crucial to see your doctor and seek help for this common and treatable problem.
Why are pregnant and new mothers more susceptible to SUI?
During pregnancy, as your baby grows, he or she pushes down on your bladder, urethra and pelvic floor muscles. Over time, this pressure can weaken the pelvic floor muscles and lead to leaks or problems passing urine.
Problems during labour and childbirth, especially with a natural vaginal birth, can weaken the pelvic floor muscles and damage the nerves that control the bladder.
Is there something women can do at home to help manage SUI?
Depending on the severity of the SUI, you can do some things at home that can help or lower your risk for SUI. These include:
Doing Kegel exercises
Kegel exercises, also known as pelvic-floor exercises, involve repeatedly contracting and relaxing the muscles that form part of the pelvic floor. To do Kegel exercises, firstly make sure your bladder is empty, then sit or lie down. Tighten your pelvic floor muscles as though you are using these muscles to stop yourself from peeing. Hold tight and count to 5 seconds. Relax these pelvic floor muscles and then repeat 10 times, 3 times a day – morning, afternoon and night. It doesn’t take long!
Training your bladder
This Step-by-step training technique involves firstly keeping a written record for a few days (or keep it on your phone) of all the times you need to urinate and leak urine in a day. Step two is to calculate the average number of hours you wait between urinations in a day. The third step is to choose a comfortable amount of time between when you will consciously visit the bathroom to urinate. Try to hold back during this interval and wait for the specified time to visit the washroom. The last step is to gradually increase the interval time between urinating. This method can be very successful for some women.
Reach or maintain a healthy weight
Eat foods with fibre to help prevent constipation and ensure you have a balanced diet with the majority of your nutrition coming from fresh vegetables, clean proteins, no (or very limited) sugar and as few processed foods as possible.
How do you test to establish the seriousness of each case?
During a consultation the sequence of symptoms, signs, urodynamic observations and conditions corresponds well to the ascending levels of patient evaluation. We need to understand the character of female urinary incontinence, as well as the underlying pathophysiology of the condition.
Women with less bothersome symptoms may be suitable for a non surgical, conservative therapy. For women who have symptoms that cause more concern, surgical intervention should be considered, but your doctor will conduct an assessment and advise you on the right course of action for you.
What are the remedies, treatments for SUI?
One of the best and latest treatments for SUI is FemiLift CO2 laser, which is a treatment using micro-ablative energy to achieve a deep thermal effect and stimulate collagen renewal, inducing rejuvenation and tissue re-modeling. FemiLift treats the entire pre-urethral space, increasing the thickness of the vaginal walls and providing better support to the mid urethra. The result is a significant reduction in stress urinary incontinence.
What do you say to women who are embarrassed to go to the doctor?
SUI is remarkably common and many pregnant women and mothers go through this. In nearly 100% of cases, it is completely natural to feel embarrassed, with some sufferers even feeling ashamed. However, if it is affecting your quality of life, then it is far better for you to make the decision to take action to remedy it, rather than remain embarrassed about suffering! It’s good to remember that SUI is the most common type of urine leakage that occurs in women. About 1-in-3 women will experience some degree of SUI during their lifetime, so you are not alone and your doctor will know how to help you.