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STRESS INCONTINENCE

Stress Incontinence is not a normal part of ageing. You do NOT have to put up with it.

What is stress incontinence?

When your pelvic floor muscles are so weak that they cannot endure the increased pressure, urine in the bladder leaks without your intention to void.  This is called stress incontinence. Stress incontinence is more common in older women.  Child birth and other events injure the supports of the bladder causing stress incontinence. It increases during menopause or a week before menstruation due to low oestrogen level.

Understanding urine and the bladder

Urine is made in the kidney constantly, which is stored in the bladder. The amount of sweating, eating and drinking contributes to the amount of urine.

The bladder is made of muscles. As the urine enters the bladder it inflates like a balloon. With help from the muscles, the outlet is kept closed so the urine cannot leak out.

When you go to the toilet to void, the bladder muscle contracts to push urine out of the bladder, while at the same time the pelvic floor muscles relax.

What causes stress incontinence?

Pelvic floor muscles are contributing to control of the movements of the bladder by folding the bladder and rectum. Stress incontinence can emerge if the pelvic floors are too weak to have control over the movements.

Child birth is the most common cause of the weakening of the pelvic floor muscles which leads to stress incontinence.

As you are aging the muscles become weaker, particularly after the menopause. Another cause of stress incontinence is obesity.

Can stress incontinence be prevented?


Doing regular pelvic floor exercises during pregnancy and after child birth can help to reduce the risk of weakening the pelvic floor muscles and hence stress incontinence.  The pelvic floor muscles are a group of muscles that wrap around the underside of the bladder and rectum.  It is important that you exercise the correct muscles. 

Some general lifestyle measures which may help

Your GP may refer you to the local continence adviser. Continence advisors can give advice on treatments, especially pelvic floor exercises. If incontinence remains a problem, they can also give lots of advice on how to cope. For example, they may be able to supply various appliances and aids to help such as incontinence pads etc.
Getting to the toilet. Make this as easy as possible. If you have difficulty getting about, consider special adaptations like a handrail or a raised seat in your toilet. Sometimes a commode in the bedroom makes life much easier.
Obesity. It is known that stress incontinence is more common in women who are obese. If you are obese, losing weight may help to ease the problem.
Smoking can cause cough which can aggravate symptoms. It would help not to smoke.


What are the treatment options for stress incontinence?

Non-surgical options such as pelvic floor exercises or even insertion of a tampon at the time of physical activities causing the leakage. Medication may be advised in addition to pelvic floor exercises. 
Surgical treatment:   this can be performed vaginally or combined with prolapse surgery.  The surgery may involve usage of permanent material called mesh (sling or TVT).
Injectables: a collagen material is placed around the bladder neck.

Dr. Jose L. Goncalves 

Obstetrics and Gynecology, Pelvic and Reconstructive Surgery