Stress Urinary Incontinence – Treatment in Jaipur: When we say Stress Urinary Incontinence (SUI), we all know it is when urine leaks a little with a little pressure in the abdomen. Being the most common type of urinary incontinence, Stress incontinence can happen during any form of physical activity like coughing, sneezing, laughing, exercise and lifting heavy weights. This condition is very common in females as compared to males.
There is some degree of stigma associated with this condition. There is some hesitancy due to which patients do not open up about this condition. A Urologist is a trained specialist to deal with Urinary incontinence. There is no need to hesitate at all, you can talk and discuss freely about any issues that you might have. Let us discuss more about it below.
Types of Urinary Incontinence
Stress Urinary Incontinence
The topic we are discussing today, stress urinary incontinence refers to a condition where you release a little bit of urine involuntarily while doing a physical activity like I mentioned above.
Urge Incontinence
This is a condition when the patient has a sudden and strong urge to pass urine. The patient is unable to hold the urine. It is interesting to note that more than 50% patients who suffer from stress incontinence, also have urge incontinence.
It should be noted that Urge Incontinence is due to Overactive bladder which is a Urinary bladder problem. Whereas, Stress incontinence is a problem related to the Urethral sphincter.
When both Stress and Urge Incontinence co-exist, the condition is known as Mixed incontinence. (We have the machines to diagnose them individually as well as together, we will talk about them below in detail.)
Overflow Incontinence
As the name suggests, in this case, the bladder becomes over stretched and urine leaks because the amount of urine exceeds the bladder capacity or you cannot completely empty the bladder.
What is the Cause of Stress Urinary Incontinence?
Normally, our Kidneys make urine. This urine flows down through the urine pipes called “ureters”. Ureters carry urine from kidney into the urinary bladder. When the bladder is nearly full, and we feel the need (and are ready) to pass the urine, the bladder muscles contract and release the urine through the urethra (the small tube when carries urine from urinary bladder to outside body). This urethra has a sphincter muscle, which is like a door. It prevents urine leakage out of the body. when the bladder muscles contract, the sphincter relaxes (opens) and we are able to pass urine comfortably.
In stress urinary incontinence, whenever the patient coughs, sneezes, etc, the sudden pressure on the bladder causes the sphincter muscles to open momentarily. In this time, the urine leaks out causing urine incontinence. When SUI becomes more severe, urine may also leak out while doing normal activities like standing up from sitting position, walking and bending over.
The amount of urine that leaks depends on the length of time the sphincter muscle remain open. It can be from a few drops or enough to soak through the clothes.
Risk Factors for Developing Stress Urinary Incontinence
- Pregnancy
- Childbirth ( Vaginal Birth > Caesarean Section)
- Surgery In Lower Abdominal or Pelvic Area
- Injury to Urethral Area
- Smoking
- Prostate Surgery in Men
- Nerve Injuries in the Lower Back
- Obesity
- Chronic Cough
- Diabetes
- Uterine Prolapse
- Unknown Causes
Diagnosis of Stress Urinary Incontinence
When a patient comes to us with complains of Urinary leakage. History and examination are very important to ascertain any risk factor associated with the symptoms patient is complaining of. There are some specific tests which help us come to a definitive diagnosis. The tests that are done are
Urinalysis – You are asked to give a urine sample in the laboratory which then checks the sample for any infections or blood traces in the urine. This test is necessary because it determines if you have UTI in which case the management goes in a different direction.
Ultrasound Pelvis – A pelvic ultrasound is conducted which checks your bladder capacity as well as residual urine volume. This test determines whether you’re completely emptying your bladder after peeing.
Cystoscopy – In cystoscopy, the urologist uses a scope to see the urinary tract upto the bladder in order to rule out any local causes of the problem.
Bonney’s Test – This a physical bladder stress test which is carried out by a well trained urologist only. This test is able to determine if the urine leak is occurring immediately or otherwise. This helps decide the type of incontinence. This test also helps the urologist decide whether the patient would benefit from surgery or not.
Urodynamic Test – This is an advanced and modern test done at a Urodynamic Laboratory (available at Institute of Urology, Jaipur). This is one of the most helpful tests which tells us about how the bladder, sphincters and urethra are holding and releasing urine individually as well as collectively.
Management of Stress Urinary Incontinence
After a diagnosis is made, the urologist now decided the best plan of treatment individualised for your case. In milder cases, conservative management and medical management may be advised. But in cases where the incontinence is severe or when medical management is not able to control the problem, surgical treatment may be suggested.
Conservative Management
Kegel Exercises for Urinary Incontinence
Kegel exercises, aka Pelvic Floor Exercises help to strengthen the muscles of pelvic floor region. This exercise is routinely suggested after childbirth for the same reason. It is done by contracting and relaxing the pelvic floor muscles. This exercises helps by making the muscles stronger.
Vaginal Devices like Pessary which support bladder and urethra, Urethral plugs to prevent incontinence during high activity.
In males, condom catheters are able to catch the leakage. But these do not prevent the leakage.
Medical management
Drugs like Duloxetine are approved for use in Stress Urinary Incontinence in women. This medicine works by increasing the activity of the nerve that stimulates the urethral sphincter, thereby improving its function.
Definitive Surgery
When the leakage is high, or when the patient does not show relief from symptoms by conservative or medical management, we have surgical treatment options.
By the help of surgery, the urethra or bladder neck is supported by stitches or “slings”. These slings can be taken from other parts of the body of the patient for example abdominal wall fascia (fascial sling), from other person (donor sling) or surgical mesh slings are also available nowadays.
The advantage of surgical sling is that, is it minimally invasive, there is no need of any large incision on the abdomen. There are total 3 small incisions put in these surgical sling procedures which are mainly of 2 type
Transvaginal Tape “Sling” – here one small incision is given in the vagina and two small lower abdominal incisions.
Transobtrurator Tape “Sling” – Here one small incision is given in vagina and the other two small incisions are given in the groin/thigh area.
The surgical approach in women is usually very successful.
After the Surgery
Proper after surgery care helps prevent any complication as well as helps maintain the good results for a long time. Patients are advised to resume Kegel’s exercises as advised by the consulting urologist. Avoid extra activities that tend to cause a lot of pressure in the abdomen.
Last but not the least, follow up is very important in all surgical cases. Make sure to always come for follow up as instructed by your urologist.
