Stress Urinary Incontinence is the complaint of involuntary leakage of urine during coughing or sneezing or any other strain like lifting weight. Stress incontinence is usually the result of the weakening of or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter.
Occasionally patient will have frequency of urination and urgency only, but the stress leak will be detected by the urologist or gynaecologist on examination. Unless associated stress leak is treated, urgency or urge leakage may not be cured.
These problems may be caused by damage during childbirth, increased pressure on your tummy – for example, because you are pregnant or obese, damage to the bladder or nearby area during surgery – such as hysterectomy or neurological conditions – that affect the brain and spinal cord, such as Parkinson’s disease or multiple sclerosis and certain medications.
How Is The Diagnosis Made?
This usually includes physical examination, urine routine examination to rule out infection, ultrasound of urinary tract and residual urine measurement, cystoscopy and urodynamic tests.
What Are The Treatments Available?
Lifestyle Changes:
Such as losing weight and cutting down on caffeine, altering how much fluid you drink a day and alcohol
Pelvic Floor Exercises:
Exercising your pelvic floor muscles by squeezing them, taught by a specialist.
Surgical Management
Certain surgical interventions help in curing the stress Incontinence.
Mid Urethral Tapes:
Tape is a thin strip of surgical mesh inserted through cuts (incisions) inside the vagina and groin or lower abdomen and threading the tape behind the tube that carries urine out of the body (urethra).
The sling can be made of:
Tissue taken from another part of your body (autologous sling) – from thigh or abdominal wall.
Polypropelene meshes – These can be fitted from thigh to thigh (TOT or TVT-O, or from lower abdomen (TVT).
Colposuspension:
Colposuspension involves making an incision in your lower abdomen, lifting up the neck of your bladder, and stitching it in this lifted position. This can be done either by open operation- open colposuspension or by laparoscopic (keyhole) colposuspension – where surgery is carried out through one or more small incisions.
Artificial Urinary Sphincter:
In severe cases or if you have had previous surgery for stress incontinence, it may be suggested that you have an artificial urinary sphincter fitted.
An artificial sphincter consists of 3 parts:
A circular cuff that is placed around the urethra – this can be filled with fluid when necessary to compress the urethra and prevent urine passing through it.
A small pump that contains the mechanism for controlling the flow of fluid to and from the cuff.
A small fluid-filled reservoir in the abdomen – the fluid passes between this reservoir and the cuff as the device is activated and deactivated.
If you are suffering from stress urinary incontinence, talk to your doctor about the available treatment options.
Dr. Suresh Radhakrishnan, MBBS, MS (Gen), MRCSED, MD (Uro-Oncology), FRCS (Urol), CCT(UK) is a Senior Consultant, Urology, Dr. Rela Institute & Medical Centre, Chennai
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