Stress Urinary Incontinence

Symptoms

The main symptom of stress incontinence is leaking urine when you:

• Are physically active
• Cough
• Exercise
• Have sexual intercourse
• Sneeze
• Stand

Exams and Tests

Your health care provider will perform a physical exam. This will include:

• Genital exam in men
• Pelvic exam in women
• Rectal exam

Tests may include:

• Cystoscopy to look inside the bladder.
• Pad weight test: You exercise while wearing a sanitary pad. Then the pad is weighed to find out how much urine you lost.
• Voiding diary: You track your urinary habits, leakage and fluid intake.
• Pelvic or abdominal ultrasound.
• Post-void residual (PVR) to measure the amount of urine left after you urinate.
• Urinalysis to check for urinary tract infection.
• Urinary stress test: You stand with a full bladder and then cough.
• Urodynamic studies to measure pressure and urine flow.
• X-rays with contrast dye to look at your kidneys and bladder.

Treatment

Treatment depends on how your symptoms affect your life.

There are 4 types of treatment for stress incontinence:

• Behavior changes
• Medicine
• Pelvic floor muscle training
• Surgery

BEHAVIOR CHANGES

Making these changes may help:

• Drink less fluid (if you drink more than normal amounts of fluid).
• DO NOT hold it. Urinate when you first feel the urge. This may help reduce the amount of urine that leaks.
• Avoid jumping or running.
• Take fiber to avoid constipation, which can make urinary incontinence worse.
• Quit smoking. This can reduce coughing and bladder irritation. Smoking also increases your risk for bladder cancer.
• Avoid alcohol and caffeinated drinks such as coffee. They can cause the urge to urinate.
• Lose excess weight.
• Avoid foods and drinks that may irritate your bladder. These include spicy foods, carbonated drinks, and citrus.
• If you have diabetes, keep your blood sugar under good control.

PELVIC FLOOR MUSCLE TRAINING

There are different ways to strengthen the muscles in your pelvic floor.

• Biofeedback: This method can help you learn to identify and control your pelvic floor muscles.
• Kegel exercises: These exercises can help keep the muscle around your urethra strong and working well. This may help keep you from leaking urine.
• Vaginal cones: You place the cone into the vagina. Then you try to squeeze your pelvic floor muscles to hold the cone in place. You can wear the cone for up to 15 minutes at a time, two times a day. You may notice improvement in your symptoms in 4 to 6 weeks.
• Pelvic floor physical therapy: Physical therapists specially trained in the area can fully evaluate the problem and help with exercises and therapies.

MEDICINES

Medicines tend to work better if you have mild to moderate incontinence. Your provider may prescribe one or more medicine. (These medicines do not always work with stress urinary incontinence.)

• Anticholinergic medicines help relax the muscles of the bladder. They include oxybutynin (Oxytrol, Ditropan), tolterodine (Detrol), darifenacin (Enablex), trospium (Sanctura), and solifenacin (Vesicare).
• Antimuscarinic drugs block bladder contractions.
• Beta agonist such as mirabegron (Mrybetriq): Enhances bladder relaxation.
• Estrogen therapy may help improve symptoms in women who have gone through menopause. It is applied as a cream or inserted into your vagina as a tablet or ring.
• Imipramine, an antidepressant, helps relax bladder muscles.

SURGERIES

If other treatments do not work, your provider may recommend surgery. Surgery may help if you have severe incontinence. Most providers suggest surgery only after trying other treatments.

• Anterior vaginal repair helps restore weak and sagging vaginal walls. This is used when the bladder bulges into the vagina (prolapse).
• Artificial urinary sphincter: This is a device used to keep urine from leaking. It is used mainly in men.
• Bulking injections make the area around the urethra thicker. This helps control leakage. The procedure may need to be repeated after a few months or years.
• Male sling is a mesh tape used to put pressure on the urethra. It is easier to do than placing an artificial urinary sphincter.
• Retropubic suspensions lift the bladder and urethra.
• Tension-free vaginal tape supports the bladder and urethra.
• Vaginal sling procedures use a sling to support the urethra.

If you have trouble completely emptying your bladder, you may need to use a catheter. This is a very small tube you place in your urethra to drain urine from your bladder.

Outlook (Prognosis)

Getting better takes time, so try to be patient. Symptoms most often get better with nonsurgical treatments. However, they will not cure stress incontinence. Surgery can cure some people of stress incontinence.

Treatment does not work as well if you have:

• Conditions that prevent healing or make surgery more difficult
• Other genital or urinary problems
• Past surgery that did not work

Possible Complications

Physical complications are rare and most often mild. They can include:

• Wearing away of materials placed during surgery, such as a sling or artificial sphincter
• Fistulas or abscesses
• Irritation of the vagina lips (vulva)
• Pain during intercourse
• Skin sores in people who can't get out of the bed or chair
• Unpleasant odors
• Urinary tract infections
• Vaginal discharge

The condition may get in the way of social activities, careers, and relationships. It also may make you feel embarrassed or bad about yourself.

When to Contact a Medical Professional

Call your provider if you have symptoms of stress incontinence and they bother you.

Prevention

Doing Kegel exercises may help prevent symptoms. Women who are pregnant may want to do Kegels during and after pregnancy to help prevent incontinence.

References

Hashim H, Abrams P. Evaluation and management of men with urinary incontinence. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 72.

Kobashi KC. Evaluation and management of women with urinary incontinence and pelvic prolapse. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 71.

Resnnick NM. Incontinence. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 26.