INCONTINENCE, STRESS |
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DESCRIPTIONStress incontinence is an involuntary loss of urine in females that accompanies any action that suddenly increases pressure in the abdomen. The urinary bladder and urethra are involved. Females of all ages can be affected.
Appropriate health care includes:
Self-care.
Doctor's treatment.
Surgery to tighten relaxed or damaged muscles that support the bladder.
SIGNS & SYMPTOMS
Unintentional loss of urine with lifting, sneezing, singing, coughing, laughing, crying, or straining to have a bowel movement.
CAUSES
Shortening 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.
RISK FACTORS
Repeated childbirth.
Obesity.
Chronic lung disease with a cough.
PREVENTING COMPLICATIONS OR RECURRENCEInstructions for your daughter:
Eat a normal, well-balanced diet and exercise regularly to build and maintain muscle strength.
Learn and practice Kegel exercises (see HOME CARE) after childbirth, before symptoms of stress incontinence begin.
BASIC INFORMATION
MEDICAL TESTS
Your own observation of symptoms.
Medical history and physical exam by a doctor.
Urinalysis to determine if a urinary-tract infection is causing your daughter's symptoms.
POSSIBLE COMPLICATIONS
Complete loss of urinary control. This requires surgery.
Urinary-tract infections.
Social isolation due to concern about embarrassment.
PROBABLE OUTCOME
If the stress incontinence is not severe enough to require surgery, exercise can improve your daughter's muscle function. If it is severe, it can be cured with surgery.
TREATMENT
HOME CAREInstructions for your daughter:
Learn to recognize, control, and develop the muscles of the pelvic floor. These are the ones you use to interrupt urination in mid-stream. 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 urinating when using the toilet.
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.
Wear absorbent underpants.
MEDICATION
Medicine usually is not necessary for this disorder, but your doctor may prescribe:
--Antibiotics if your daughter has a complicating urinary-tract infection.
--A pessary (support device) made of rubber or other material to fit inside the vagina to support the uterus and lower muscular layer of the bladder.
See Medications section for information regarding medicines your doctor may prescribe.
ACTIVITY
No restrictions.
DIET & FLUIDS
Your daughter should lose weight if she is obese.
OK TO GO TO SCHOOL?When signs of infection have decreased, appetite returns and alertness, strength, and feeling of well-being will allow.
CALL YOUR DOCTOR IF
Your daughter has 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 your daughter wishes to consider surgery.
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