STRESS INCONTINENCE |
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General Information
DEFINITION--An involuntary loss of urine in women that accompanies any action that suddenly increases pressure in the abdomen. This is most common when jumping, running or straining (as with lifting weights).
SIGNS & SYMPTOMSUnintentional loss of urine with exercise, lifting, sneezing, singing, coughing, laughing, crying or straining to have a bowel movement.
CAUSES & RISK FACTORSShortening of the urethra and loss of the normal muscular support for the bladder and floor of the pelvis. These changes occur during pregnancy and after childbirth, particularly repeated childbirth. They may also occur as a natural consequence of aging. They are made worse by obesity.
HOW TO PREVENT
Empty your bladder before exercise.
Eat a normal, well-balanced diet and exercise regularly to build and maintain muscle strength.
Learn and practice Kegel exercises (see Home Treatment) after childbirth, before symptoms of stress incontinence begin. If you have passed menopause, practice Kegel exercises even if you have not given birth.
WHAT TO EXPECT
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor.
Urinalysis to determine if a urinary-tract infection is causing the symptoms.
SURGERYSometimes necessary to tighten relaxed or damaged muscles that support the bladder. This surgical procedure is called ANTERIOR COLPORRHAPHY. It may be performed alone or in conjunction with other gynecological surgery, especially vaginal hysterectomy.
NORMAL COURSE OF ILLNESSIf the stress incontinence is not severe enough to require surgery, exercise can improve the muscle function. If it is severe, it can be cured with surgery.
POSSIBLE COMPLICATIONS
Complete loss of urinary control. This requires surgery.
Recurrent or chronic urinary-tract infections.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
MEDICAL TREATMENTNot usually necessary nor useful unless complications develop, especially urinary-tract infection or total loss of control.
HOME TREATMENTLearn to recognize, control and develop the muscles of the pelvic floor. These are the ones you use to interrupt urination in midstream. The following exercises (Kegel exercises) strengthen these muscles so you can control or relax them completely:
To identify which muscles are involved, alternately start and stop urination when using the toilet. Another method is to place a finger just inside the opening of your vagina and squeeze the finger with your vaginal muscles.
Practice tightening and releasing these muscles while sitting, standing, walking, driving, watching TV or listening to music.
Tighten the muscles a small amount at a time "like an elevator going up to the 10th floor." Then release very slowly, "one floor at a time."
Tighten the muscles from front to back, including the anus, as in the previous exercise.
Practice exercises every morning, afternoon and evening. Start with 5 times each, and gradually work up to 20 or 30 each time.
MEDICATIONMedicine usually is not necessary for this disorder, but your doctor may prescribe:
Antibiotics if you have a complicating urinary-tract infection.
A pessary (support device) made of plastic, rubber or other material to fit inside the vagina to support the uterus and lower muscular layer of the bladder.
ACTIVITYNo restrictions.
DIETFollow a weight-loss diet if you are obese.
CALL YOUR DOCTOR IF
You have symptoms of stress incontinence.
Any sign of infection develops, such as fever, pain on urination, frequent urination or a general ill feeling.
Symptoms don't improve after 3 months of Kegel exercises, or symptoms become intolerable and you wish to consider surgery.
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