Stress incontinence is very uncomfortable for those affected. The involuntary discharge of urine can be well caught by hygienic pads, but affects the quality of life of patients. They can no longer move as freely as before.
What is stress incontinence?
Stress incontinence is called stress incontinence in modern medicine. This refers to physical strain on the bladder sphincter. Stress incontinence is associated with involuntary leakage of urine due to increased pressure in the lower abdomen. Patients leak urine when they sneeze or climb stairs. Patients – most of those affected by this form of incontinence are female – do not feel any urge to urinate beforehand. Depending on the severity of the condition, medicine distinguishes between three different degrees. Coughing, laughing, sneezing and jumping are considered heavy physical exertion (grade 1). Standing up, sitting down, climbing stairs, and walking are considered mild physical exertion that results in involuntary loss of urine (grade 2). If urine is lost at rest, for example when lying on the sofa, grade 3 stress incontinence is present. In stress incontinence, patients lose little (a few droplets) or a lot of urine (stream). Stress incontinence is more common in women than in men. It also affects more older patients than younger ones. To prevent soiling underwear, other textiles, and the living environment, patients use incontinence pads.
Causes
Stress incontinence can have diverse causes. It often results from constitutional or acquired pelvic floor weakness. Patients have genetically determined connective tissue that is too weak or it was caused by pregnancies and natural childbirth. Congenital malformation or acquired damage to the bladder sphincter can also lead to stress incontinence. In female patients, uterine and vaginal prolapse and uterine removals also cause incontinence. Other culprits in both men and women include: severe obesity, heavy physical labor, chronic bronchitis, bladder infections, nerve damage to the urinary bladder area, and prostate cancer. However, women who deliver their children naturally do not have to worry about having to endure the involuntary leakage of urine that occurs during pregnancy for the rest of their lives: Only about six percent suffer from stress incontinence afterwards. In men, involuntary urination often occurs after prostate removal.
Symptoms, complaints and signs
Stress incontinence manifests as the loss of smaller and more extensive amounts of urine. In more severe stress incontinence, urine passes even in patients who are resting and those who are barely moving physically. Although the uncontrolled loss of urine is not associated with pain, it is extremely unpleasant for those affected. They fear that people nearby will notice that they have wet themselves.
Diagnosis and course of the disease
The attending physician first takes a detailed medical history. To be able to rule out a urinary tract infection with certainty, he has the patient’s urine examined. A general physical examination, especially of the genital and anal regions, and neurologic tests should provide further information about the stress incontinence present. If bladder dysfunction is definitely present, the physician’s further course of action depends on the extent of the stress incontinence. Imaging techniques (ultrasound, CT), cytoscopies, urethra calibration, blood tests and are used. A micturition log for the two days prior to the medical examination will provide further information.
Complications
Stress incontinence can cause several complications. Involuntary urinary leakage primarily affects the psyche of those affected, who often develop anxiety and withdraw from social life. In particular, prolonged complaints thus represent a great psychological burden for the sufferers. In extreme cases, pronounced anxiety disorders, inferiority complexes or depression develop. A possible physical effect of stress incontinence is inflammation in the intimate area. Particularly in the case of poor hygiene, urine is the basis for bacterial diseases and complaints such as itching, redness and abscesses. Adverse events can also occur during treatment.Taking medications is occasionally associated with side effects and interactions. Typical complaints are hypersensitivity reactions, gastrointestinal problems and shortness of breath. During pelvic floor training, there is a risk of germs entering the vagina and leading to urinary tract infections. In addition, pressure ulcers can occur. In extreme cases, electroshock therapy can lead to neurological complaints or cardiac arrhythmias. Biofeedback also carries risks: In cases of existing mental illness, the procedure can cause serious complications and sometimes exacerbate the underlying condition. Last, bleeding and wound healing problems can occur during surgery.
When should you see a doctor?
People who suffer from a persistent experience of stress should always consult a doctor or therapist. Persistent stress leads to various health disorders that must be counteracted in time. If the affected person also suffers from involuntary urination, there is a need for action. If psychological problems occur due to the irregularities, a doctor is needed. Shame, a withdrawal from social life, or anxiety are signs of irregularity. They indicate problems that should be followed up. A reduced quality of life or a lowered sense of well-being lead to various illnesses in the long run. Therefore, a doctor should be consulted if symptoms persist for several weeks or months. If there is an involuntary loss of urine when coughing, laughing, moving around or sneezing, a doctor should be informed of the observations. Fatigue, sleep disturbances or nocturnal enuresis are other signs that should be investigated. An investigation of the cause is necessary so that a diagnosis can be made and a treatment plan established. If the impairments lead to an inability to work or interpersonal problems, the affected person needs help. Personality changes, abnormal behavior or listlessness are considered warning signs that should be followed up. In many cases, the affected person is not aware of the stress triggers to which they are exposed on a daily basis. For clarification and awareness, they need support.
Treatment and therapy
Treatment is conservative or via surgery, depending on the severity of the condition. Proven conservative methods include pelvic floor exercises, biofeedback, electrical stimulation, use of a pessary, taking medications, and combination therapies (drug-physiotherapeutic). In pelvic floor gymnastics, after initial instruction by the physical therapist, the patient performs various simple exercises that strengthen the muscles and ligaments of the supporting apparatus. He learns to use them consciously as needed in everyday life as well. With biofeedback, he also receives a visual and acoustic response when he performs the prescribed exercises correctly. This technique can be supplemented by other methods and equipment such as electrostimulation and the magnetic chair. In electrostimulation, the sphincter muscle is not tensed by the patient himself, but stimulated by electrodes inserted into the anus or vagina. Only suitable for women is the insertion of a pessary into the vagina. It lifts the bladder neck or uterus. Pulling activates the spreader muscle and lifts the urethra and bladder muscle. Drug treatment is with the help of estrogen administration or prescription of a selective serotonin–norepinephrine reuptake inhibitor (SSNRI). Duloxetine, for example, causes an increased release of neurotransmitters. Also suitable only for women are feminacones, tampon-like weights of varying weights that are inserted into the vagina to exercise the pelvic floor. If stress incontinence requires surgical treatment, the choice of surgical method depends on whether uterine descent or stress incontinence is more pressing. If involuntary urination causes more problems, a stabilizing band made of plastic (TOT, TVT) is inserted. If there is muscle weakness in the pelvic floor area, a vaginal perineoplasty is performed. In the case of very severe stress incontinence, only the insertion of an artificial sphincter (AMS sphincter, Pro-ACT) will help. Implacement therapy is innovative: the minimally invasive procedure consists of relining the urethra tissue with microparticles contained in a hyaluronic acid matrix.
Prevention
Drinking plenty of fluids throughout the day is recommended as a preventive measure. It exercises the bladder sphincter. In addition, preventive floor pelvic gymnastics (for both sexes!) has proven to be very effective. Under no circumstances should the patient reduce his daily fluid intake, otherwise the capacity of his urinary bladder will be permanently reduced.
Aftercare
No general statements can be made about aftercare for stress incontinence. Whether specific measures are necessary sometimes depends on the cause and form of the condition, the therapy chosen, and the success of treatment in each case. After a surgical intervention, several control examinations are necessary. In particular, the healing of the surgical wound is monitored. As a rule, the wound must be treated for several weeks. Healing is accelerated by daily application of an ointment. Often there is an unpleasant itching. For this reason, repeated sitz baths are often recommended. In general, strict body hygiene should be observed. Bandages should definitely be changed daily. Depending on the underlying disease, various other measures are also required. In many cases, relapses occur despite initially successful treatment. Regular check-ups with a general practitioner or, depending on the cause of the stress incontinence, with a urologist, gynecologist or other specialist are therefore necessary. Those affected should also seek advice from specialists in stoma care. To better manage the condition in everyday life, they should familiarize themselves with the use of incontinence equipment such as adult diapers or pads. Because stress incontinence is usually a major psychological burden, long-term psychotherapeutic care is often necessary.
Here’s what you can do yourself
There are some things patients with stress incontinence can do to relieve symptoms. Incontinence remedies such as panties, disposable briefs or anal tampons make everyday life with the condition easier. An incontinence product should be used especially in stressful life situations. Regular toilet use is equally important. Urinating too frequently can cause the bladder to become habituated and increase the urge to urinate. Very infrequent urination, on the other hand, can lead to overstretching of the bladder muscles. If excess weight is present at the same time, it must be reduced. Excess weight leads to high pressure in the abdominal cavity and increases incontinence. Since incontinence leads to a greater germ load on the skin, care should be taken with personal hygiene. The intimate area in particular must be adequately cleaned. If, at the same time, a bladder-friendly diet is followed by avoiding black spices or coffee, stress incontinence should noticeably decrease after just a few days. However, the trigger for the symptoms must also be eliminated. It is important to reduce stress factors in everyday life and at work and to create additional calm and balance through relaxation exercises such as autogenic training.
