People with stress incontinence lose urine involuntarily during physical activities that put pressure on the abdomen.
This type of incontinence is often seen in women after they reach middle age. A weak pelvic floor and a poorly supported uretheral sphincter cause stress incontinence.
Activities commonly associated with stress incontinence include the following:
Stress incontinence occurs when the bladder neck and urethra do not close properly. When these structures move down and bulge (herniate) through weakened pelvic floor muscles, they are said to be hypermobile.
Herniation, or cystocele, changes the angle of the urethra, which causes it to remain open and allow urine to leak out. There are three classifications of stress incontinence.
Risk factors include childbirth, menopause, and pelvic surgery (e.g., prostatectomy, hysterectomy).
Pregnancy and childbirth can flatten, stretch, and weaken the pelvic floor muscles that support the bladder neck and urethra.
The position of the bladder and urethra may change, bladder control nerves may be damaged, or an episiotomy (incision of the perineum and vagina) may be performed to prevent tearing during vaginal delivery. These complications will weaken the pelvic floor muscles.
If bladder control is lost immediately after childbirth, the pelvic floor muscles may recover within 6 weeks. If continence is not regained, treatment may be required.
Sometimes incontinence develops months or years after childbirth. Women who exercise the pelvic floor muscles (Kegel exercises) are less likely to develop incontinence.
At menopause, the ovaries stop producing estrogen. Lack of estrogen results in thinned tissues that line the urethra, a weakened sphincter mechanism that opens and closes the urethra, and weak bladder muscles.
These factors can cause the urethral sphincter to open during physical activity.
Pelvic surgery can weaken and damage the pelvic floor muscles, causing the bladder neck and urethra to drop when abdominal pressure is applied (hypermobility) during physical activity.
Surgical procedures that may affect the pelvic floor muscles include the following:
Causes of Stress Incontinence
Stress incontinence is caused by the following:
Signs and Symptoms
Urine leaks during strenuous physical activity
Management of Stress Incontinence
The FemSoft® insert is a disposable, single-use device for the treatment of female stress urinary incontinence. It consists of a narrow silicone tube enclosed in a soft, thin, mineral oil-filled sleeve that forms a balloon at the tip. At the opposite end, the sterile tube and sleeve form an external retainer.
FemSoft® is inserted into the urethra with a disposable plastic applicator. As the device is inserted, the mineral oil in the balloon drains into the external retainer. Once the tip of the device is advanced to the bladder, the oil flows back into the balloon, creating a seal at the neck of the bladder that prevents urine leakage.
FemSoft® is removed and discarded when the patient wants to urinate and afterward, a new device is inserted.
UTI, bacteriuria, urgency, frequency, and nocturia are potential complications.
Vaginal pessaries are silicone or latex devices inserted into the vagina to compress the urethra and support the bladder neck to prevent leakage during strenuous activity. Pessaries are available in different shapes and sizes.
The incontinence ring and incontinence dish shapes are commonly used to treat stress incontinence. Women who experience leakage only during exercise may find that the cube pessary inserted before activity is all that is needed.
A pelvic examination is performed first to make sure there is no infection. An infection must be treated before a pessary can be used.
Pessaries usually are fitted and inserted by a gynecologist and the largest size that can be worn comfortably is usually the most effective. Once in place, the patient is asked to cough to test for leakage.
Frequent follow-up care is required to check for infection, pressure sores, and allergic reaction. If the patient is sensitive to latex or silicone, she cannot use these devices.
Pressure sores are more common in postmenopausal women. Estrogen cream can improve the integrity of the vaginal mucosa. Tissue damage is managed by removing the pessary until the skin heals. Infections are treated with antibiotics.
At each examination, the pessary is
removed and cleaned with soap and water. Diligent follow-up is essential for
eldery or debilitated patients.
It is used for stress and mixed incontinence. The device should not be worn continuously for more than 24 hours without proper cleaning and must be removed to have intercourse.
The Miniguard Patch® and Impress® are single-use foam pads that are slightly larger than a postage stamp. One side of the patch is covered with adhesive to hold it over the urethral opening and surrounding area.
It fits between the labial folds and provides pressure around the urethral opening to prevent leakage. The wearer simply removes the patch to urinate and puts on a new patch after urination.
Small, round silicone "caps" (e.g., FemAssist®, Bard Cap Sure® Continence Shields) use suction to support the urethral sphincter (muscle that opens and closes the urethra). An ointment is applied to the inner surface to create a vacuum seal that holds the cap in place.
To urinate, the wearer removes the cap, which can be washed with soap and water and reapplied. Some women experience discomfort or irritation with these devices.
External devices for men include penile clamps (e.g., Cunningham clamp) and compression rings.
The penile clamp is a V-shaped casing with a foam cushion that fits over the penis. When closed, the clamp stops the flow of urine. Compression rings fit around the penis and are inflated to pinch off urine flow.
Clamps and rings must be removed every 2 to 3 hours to empty the bladder. Only patients who can adjust them properly and adhere to the voiding schedule should use them. Improper use of these devices can cause penile and urethral tissue damage, penile edema (swelling), pain, and obstruction.
Treatments for Stress Incontinence
Injecting material to increase the bulk around the urethra can improve the function of the urethral sphincter and compresses the urethra near the bladder outlet.
Injectable agents can help women who are not candidates for surgery and have persistent intrinsic sphincter deficiency (very weak urethral sphincter) without urethral hypermobility. Injectable agents also may help men with intrinsic sphincter deficiency that has lasted longer than 1 year.
Injectable materials include collagen (naturally occurring protein found in skin, bone, and connective tissue), fat from the patient's body (autologous fat), and polytetrafluoroethylene (PTFE)and Durasphere™ (synthetic compounds).
Nonsurgical Treatment for Stress Incontinence
Surgical Treatment of Stress Incontinence
Urethral obstruction is a common complication after surgery for stress incontinence. Symptoms include the following:
Urethrolysis involves cutting obstructive adhesions (fibrous tissue bands) that fix the urethra to the pubic bone. When the procedure is performed through an incision in the vagina, it is called transvaginal urethrolysis.
This technique is associated with few complications and permits the correction of vaginal abnormalities. Transvaginal urethrolysis is the most effective procedure for mending urethral obstruction that results from surgical repair of stress incontinence.
Patients suffering from stress incontinence may benefit from alpha-adrenergic agonists, which stimulate receptors that respond to norepinephrine, a hormone and neurotransmitter.
These agents should be used with caution by patients with high blood pressure (hypertension), overactive thyroid (hyperthyroidism), irregular heartbeat (arrhythymia), or heart pain caused by insufficient oxygen supply to the heart muscle (angina).
Pseudophedrine hydrochloride is also found in cough and cold preparations and antihistamines. Typical dosage is 15-30 mg, three times a day.
Ephedrine, epinephrine, and norepinephrine are alpha-adrenergic agonists that have many effects throughout the body and must be used with caution. Significant side effects include hypertension, tachycardia (rapid heart rate), and arrhythmia (irregular heartbeat).
Hormone replacement therapy (HRT) can restore the health of urethral tissues in postmenopausal women. HRT involves estrogen to heighten bladder outlet resistance by increasing blood flow, muscle tone, and nerve response in the urethra.
Estrogen is given with progestin to avoid the risk for endometrial cancer. A typical dose is 0.3 to 1.25 mg per day. HRT may benefit patients with stress or mixed incontinence.
The above opinionated views and information serves to educated and informed consumer . The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. .It should not replaced professional advise and consultation. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions
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