Stress Incontinence: Everything You Need to Know
Peeing when you laugh,cough or sneeze is occurs due to Urinary Stress Incontinence. Urinary Stress Incontinence is a condition that affects millions of people worldwide. It happens when you leak urine during physical activities, coughing, laughing or even sneezing. It causes not just inconveniences but discomfort and embarrassment as well.
Why Stress Incontinence Happens
Normally, your bladder expands as it gets filled with urine. As this happens, your urethra, the short tube that directs your urine outside of the body, remains closed to prevent urine from leaking.
With stress incontinence, the muscles and tissues supporting your urethra and bladder become ineffective in keeping your urine inside your bladder. As a result, any activity that puts pressure on your pelvic and abdominal muscles cause urine leakage.
There are a number of reasons why this happens. For women, however, one of the most common reason is childbirth.
During delivery of a baby, a woman’s pelvic floor muscles and sphincter may experience nerve damage. Urine leakage may happen right after delivery or even a few years later.
For men, however, the most common reason for stress incontinence is prostate surgery. The surgical removal of a man’s prostate gland causes the urethra to become weak as it lies just below the gland.
Another factor for stress incontinence that increases the risk of both men and women is age. Muscles become weak as part of the normal aging process.
In addition to those three factors, stress incontinence can also happen with:
- Chronic sneezing and coughing
- Chronic constipation
- Nerve injuries to the lower back
- History of pelvic surgery
Symptoms of Stress Incontinence
The main symptom associated with this condition is the leakage of urine that happens during physical movements and activities. This includes lifting, coughing, laughing or running. The leak can be as little as a drop or a full stream of urine.
In diagnosing stress incontinence, a complete medical history is taken by your healthcare provider. This will typically include:
Past and present health
Type and volume of liquids taken per day
In addition to that, a physical exam will also be done to check the abdomen, pelvic organs, genitals, and rectum. A urinalysis, urodynamic studies, bladder scan, and cystoscopy may be required as well.
Treating Stress Incontinence
Stress incontinence is generally treated by a combination of different strategies. And if there’s an underlying condition that’s contributing to it, additional treatment may be considered.
One of those strategies involves behavior therapies which aim to eliminate or reduce the episodes of urine leakage. Some of the most common treatments doctors recommend include:
Bladder training– This refers to setting a schedule for using the toilet. Voiding more frequently may lessen the episodes.
Pelvic floor muscle exercises– Known as Kegel exercises, this treatment mainly strengthens the urinary sphincter and pelvic floor muscles.
Healthy lifestyle– Losing weight, getting a chronic cough treated, and quitting smoking can improve the condition.
In addition to behavior therapies, doctors may also prescribe medications to treat stress incontinence. One of the most commonly prescribed drugs is an antidepressant called duloxetine.
And if that doesn’t work, certain devices may be recommended to control stress incontinence. Urethral inserts and vaginal pessary are great options.
Surgery may be done if the urine leakage doesn’t respond well to behavior therapies and medications. The surgical procedures used to treat stress incontinence, however, vary between men and women.
For women with this condition, bulking agents may be injected into the urethral area to help the sphincter create a better closure to the bladder. The procedure is often done under local anesthesia and may be repeated as neccessary.
Sling surgery is another option. For this one, a small strip of metal is positioned under the urethral area to keep it from moving downward.
For men, placing an artificial urinary sphincter is considered as the most effective treatment. This device generally has three parts- a pressure-regulating balloon, a fluid-filled cuff, and a controllable pump inserted into the scrotum.
About Bowel Incontinence
Just like urine incontinence, there are also people who suffer from loss of bowel control. This results in the leakage of stools or feces from the rectum.
Affecting about 18 million people in the United States alone, the condition happens most commonly due to damage to the anal sphincters.
Bowel incontinence can also happen because of:
- Nerve damage
- Inflammatory bowel diseases
- Cognitive impairment
- Impacted stool
- Anal surgery
To diagnose bowel incontinence, doctors may need to conduct a physical examination to assess the strength of the anal sphincter. In addition to that, stool testing, endoscopy, nerve tests, and MRI defecography may also be done.
Treating bowel incontinence may include dietary changes, medications, stool impaction therapy, and bowel training.
Anti-diarrheal medications may be prescribed to reduce the episodes. If the condition happens due to impacted stool or chronic constipation, laxatives may be a better option.
Drinking more fluid and consuming more foods high in fiber may help lessen the severity of bowel incontinence. This is because high fiber foods make the stools bulkier.
Similar to bladder training, bowel incontinence can also be treated with bowel training. This may include setting certain times within the day to use the bathroom and doing specific exercises to strengthen the muscles responsible for bowel control.
If none of those things work, surgery may be done. Sphincteroplasty, for one, involves the removal of the damaged muscles in the anal sphincter. After removal, the surgeon overlaps the edges of the muscles and sew them back together in an attempt to tighten and provide better support to the sphincter.
Sacral nerve stimulation is another option. This procedure involves the placement of an electric lead within the tailbone to stimulate the nerves responsible for controlling the anus. Nerve stimulation is typically performed with a device that’s similar to a pacemaker.