Stress Urinary Incontinence

Stress Urinary Incontinence

How does the Urinary System work?

The kidneys filter the blood and create the waste product called urine which flows down both ureters and collects in the Urinary Bladder. The urethra is the tube which links the bladder to the outside and its opening is controlled by muscles which prevent involuntary leakage of urine.

When the bladder is full and the brain signals the bladder that it is alright to void, it contracts and simultaneously the muscles at the opening of the urethra relax, releasing urine.

What is Urinary Incontinence?

It is the loss of control over urination. It may be of 2 types:

Stress Urinary Incontinence wherein small to moderate amount of urine leaks without control. This happens during increases pressure on the bladder for example; coughing, sneezing or laughing.

Urge Urinary Incontinence results in moderate to large leak of urine when the bladder suddenly contracts without control. The lady typically complains that when her bladder fills up and she gets the urge, the urine seems to leak even before she reaches the toilet. This happens because of an Overactive Bladder.

Many people with SUI also have an Overactive bladder and this is called Mixed Incontinence.

How does one gauge the severity of SUI?

As mentioned before, even in times of increased bladder pressure, the urine is not supposed to leak because of the muscles at the end of the urethra. However because of weak muscles or loss of collagen, the sphincter becomes weak and the leak happens. The severity of the leak is quantified as follows:

Grade 1: Leak happens on sudden forceful activities like sneezing, laughing or coughing

Grade 2: Leak happens with less strenuous activities like standing up, walking or bending over.

Grade 3: Leak happens even while lying down.

The leaks can be restricted to a few drops or may wet clothes.

Some alarming facts about SUI:

• About 1 in 3 women suffer from SUI at some point in their lives
• About 50% of them will also have urge incontinence
• 30% of women undergoing vaginal delivery will develop SUI within 5 years of delivery.

Risk factors for developing SUI:

• Gender; females are more likely to develop SUI
• Vaginal delivery (more if forceps is used)
• Overweight
• Nerve injuries to the lower back
• Chronic cough
• Smoking
• Pelvic surgery

How do I find out if I have SUI?

You will need to come in for an evaluation wherein we will ask you to fill in a specialized chart of symptoms. This will be followed by an examination and some tests to determine the exact problem. This entire process may also involve a meeting with a Urologist.

Lifestyle Changes:

• Pelvic Floor Muscle Exercises or Kegel’s Exercise: By working and strengthening the specific muscles involved in supporting the bladder and urethra, one can reduce the symptoms of incontinence. These exercises however need to be done many times a day for a few weeks or months before you can see results.
• Ensure good bowel function: constipation has worsen incontinence thus it is imperative that you drink 6-8 glasses of water and consume a fiber rich diet every day.
• Maintain a healthy weight: obesity aggravates SUI. Weight loss would be one of the first few strategies to lessen the severity of the incontinence.
• Bladder training: Keeping a bladder diary is helpful since small changes made to your daily routine can help train your bladder to reduce the severity of the incontinence.
• Quit Smoking: smoking directly affects your health and by inducing a chronic cough, indirectly increases the incontinence.

Oral Medicines and Surgery:

Medicines and surgery for correction are viable options for correcting the stress urinary incontinence. Medicines have the disadvantage of being required every day and the associated ‘no matter how small’ side effect. Surgery on the other hand requires hospital admission, anesthesia, a very competent uro-gynac surgeon and even with all that there is no 100% guarantee that the problem will disappear.

Femilift or Fractionated CO2 laser:

A revolutionary technology that uses lasers to rejuvenate and replace the collagen tissue around the urethra and bladder walls thus tightening that area. It’s safe, effective and takes only 3 mins of therapy. For a lot many patients, one session is good enough while most will have relief after 2 or 3 sittings.