Stress Incontinence

Urinary incontinence affects millions of people of all ages and social and economic levels, although it occurs more often in older women than in young women. The two basic forms of incontinence include urge incontinence and stress incontinence. This page covers stress incontinence, which is the most common. It occurs when the muscle (sphincter) that holds the bladder’s outlet closed is not strong enough to hold back the urine.

Problems with the way the sphincter muscle opens and closes can cause stress incontinence. In addition to chronic coughing, smoking and obesity, the following physical changes to the body may also cause stress incontinence:

• Pregnancy and childbirth
• Menstruation
• Menopause
• Pelvic surgery
• Problems with muscles in the bladder – the organ that holds urine – and the urethra
• Weakened muscles around the bladder

Muscles in the pelvis can weaken and cause the bladder to drop down into a position that prevents the urethra from closing completely. This results in urine leakage.

Urinary stress incontinence occurs upon a sudden movement or activity, such as coughing, sneezing, laughing, or lifting, and causes abdominal pressure on the bladder, which triggers a small amount of urine to leak. The leakage may be as little as a drop or two, a “squirt,” or even a stream of urine.

A urologist will perform a detailed history and physical exam, so it is helpful if the patient keeps a bladder diary for a few days beforehand to record times of urination, the amount of urine, leakage, and foods and beverages consumed. The physician may also perform one of several tests:

• Urinalysis and culture testing: An examination of the composition of the patient’s urine.
• Urodynamics: A technique that measures the pressure in the bladder and urine flow.
• Post-void residual volume scan: A measure of the amount of urine left in the bladder after urination.

Conservative treatments:

• Pelvic floor exercises: Kegel (pelvic squeezing) exercises strengthen the muscles that control urination. It involves tightening, holding and then relaxing the muscles used to start and stop the flow of urination, working up to three sets of 10 a day​.
• Biofeedback: Patients who have trouble locating their Kegel muscles may benefit from biofeedback. This approach involves scheduled one-hour visits to The Urology Group Central Indiana’s office. A probe monitors the strength of the patient’s squeezing for viewing on a computer screen, effectively teaching her to repeat the exercises at home.
• Incontinence pessary:A small plastic or silicone medical device inserted into the vagina to support the urethra and stop the bladder from leaking. Some models look like a ring with a support knob, which can be left in for longer periods of time, including during sexual intercourse. Others look like tampons and are inserted similarly which can be left in for up to 12 hours. When fitted properly, the patient does not feel the pessary.

Surgical treatments:

• Mid-urethral synthetic sling (“sling procedure”): The most common procedure for stress urinary incontinence is a surgical mesh in the form of a “sling” (sometimes called “tape”) permanently implanted beneath the urethra.
• Autologous fascial sling: The autologous fascial sling uses the patient’s own tissue, taken either from the abdominal region or the thigh, to create the sling that supports the urethra. Unlike mid-urethral slings, it is placed at the level of the bladder neck.
• Urethral bulking agents: A medication is injected inside the urethra to make the space around it thicker, thus helping to control urine leakage. The effects may not be permanent.