Stress Urinary Incontinence: Causes, Diagnosis, Symptoms, and Treatment

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Stress urinary incontinence diagnosis, symptoms, and treatment

Stress Urinary Incontinence 

Stress incontinence occurs when the urethral sphincter, the pelvic floor muscles, or both of these muscle structures have been weakened or damaged, and thus cannot dependably hold in urine. The word "stress" refers to the physical strain and muscular activity associated with leakage. If urine leaks out when you jump, cough, laugh, run, walk, bend over, or do any physical exertion that increases abdominal pressure on the bladder, you may have stress incontinence.
A common misconception is that stress incontinence is based on emotionally distressing events, but this condition has nothing to do with emotion. The leakage occurs even though the bladder muscles are not contracting and you don't feel the urge to urinate. Usually only a small amount of urine leaks out and it is manageable using a sanitary napkin or disposable bed pad. In more severe cases, the pressure of physical stress on a full bladder overwhelms the body's ability to hold in urine, and the leakage has more volume. 

Causes of Stress Incontinence 

There are many reasons why someone may develop stress incontinence over the course of their life. Stress incontinence can happen due to childbirth, injury to the urethral area, surgery in the pelvic area, prostate surgery, and even some medications. To identify any problems that might be causing incontinence, it is advised to describe your symptoms in as much detail as possible to your doctor or primary healthcare practitioner.
You might be asked to keep a diary of daily urinations and volume of  fluid intake for a few days to monitor any irregular patterns of urination. Your doctor will also want to know about any surgeries, pregnancies, and medications you are taking, since certain drugs can cause incontinence by increasing urine production or relaxing muscles of the bladder or urethra. 

Diagnosis of Stress Incontinence 

In order to diagnose if you have stress incontinence, a physical exam will be necessary by your doctor. Some physicals will include a genital exam for men, a pelvic exam for women, and a rectal exam for either sex. Other tests may include getting urine samples for a urinalysis to check for a urinary tract infection (UTI), urinary stress test (standing upright with a full bladder and then coughing), a post-void residual test to measure the amount of urine left in the bladder after you urinate, a cystoscopy to look inside the bladder, pelvic or abdominal ultrasound, tests to measure pressure and urine flow, and/or an x-ray to look at the bladder and kidneys. There are many ways to test and monitor urinary symptoms to properly diagnose the type of incontinence you may have. 
The following health factors may make your stress incontinence worse:
* urinary tract infections (UTIs)
* obesity and sedentary lifestyle
* frequent coughing or smoking
* medications that increase urine production
* nerve damage or excessive urination from diabetes

Types of Stress Incontinence

Stress incontinence is divided into two subtypes: urethral hypermobility and intrinsic sphincter deficiency. 

Urethral Hypermobility

In urethral hypermobility, the bladder and urethra physically shift downward when abdominal pressure is applied to the lower torso. The effect is that there is no hammock-like support for the urethra to be compressed against and therefore causes a small opening; there is nothing for the urethra to be compressed against to keep it closed and hold urine in. 

Intrinsic Sphincter Deficiency

On the other hand, for intrinsic sphincter deficiency, problems in the urinary sphincter interfere with full closure of the sphincter or it pops open under pressure. Experts have said that some women who have delivered a child vaginally are most likely to develop stress incontinence as a result of giving birth. The birthing process has stretched and possibly damaged the pelvic floor muscles and nerves to expand for the baby's passage. Generally, the larger the baby, the longer the labor, the older the mother, and the greater the number of births, the more likely that stress incontinence will result.

Stress Incontinence in Elderly Men and Women

Age plays a factor in experiencing stress incontinence symptoms. In men, the most frequent cause of stress incontinence is urinary sphincter damage sustained through prostate surgery or a pelvic fracture. Lung conditions that cause frequent coughing, such as emphysema and cystic fibrosis, can also contribute to stress incontinence in both men and women as the pressure from the coughing makes accidental leaks more likely.
Stress incontinence is far more common among women than men. According to the American Academy of Physicians (AAP), about 50 percent of women between the ages of 40 to 60, and nearly 75 percent of women over the age of 75, have some form of urinary incontinence (UI). As a woman gets older, the muscles in her pelvic floor and urethra weaken, and it takes less pressure for the urethra to open and allow leakage. Estrogen and childbirth can also play some role in the weakening of the pelvic floor. Many women do not experience symptoms of stress incontinence until after menopause. 

Stress Incontinence Treatment

Several types of treatment are available for stress incontinence. Treatment includes a wide range of options from lifestyle changes to medications, nonsurgical treatments, and in more severe cases, surgery to correct the urethra and pelvic floor.

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