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Urinary Stress Incontinence

Urinary stress incontinence (USI) is usually defined as the involuntary or unintentional loss of urine that is brought on during physical activities such as coughing, sneezing, exercise, lifting, or laughing. USI may occur in either men or women but is more common in women. The ability to hold the urine is controlled by the normal function of the bladder, urethra, and the nervous system. Bladder control is a function that is learned and is not one that we are born with. The control of the bladder involves two sets of muscles: the sphincter that surrounds the urethra at the neck of the bladder and the pelvic floor muscles. Poor function of the either or both of the muscle groups can lead to loss of urine. The urine is stored in the bladder and it expands to accommodate the amount of urine present. The sphincters of the urethra stay contracted until you reach the bathroom to urinate. When the muscles are weakened, pressure in the bladder can stimulate the release of urine at inappropriate times. Anything that increases pressure on the abdomen can increase pressure on the bladder stimulating release of urine.

What are factors that can lead to USI?

  • Being a woman – USI is much more frequent in women than in men.
  • Childbirth – the stress on the muscles during pregnancy as well as risk of trauma to the muscles during delivery can weaken the muscles. A recent study showed that women who carry three pregnancies and have Cesarean sections still have the same effect as delivering a child vaginally.
  • Urinary tract infections – during a urinary tract infections, inflammation occurs and may affect the sphincter control.
  • Obesity – increases pressure on the pelvic muscles and bladder thus leading to a higher risk of leakage. Studies have shown that losing 25 pounds can reduce the frequency of leakage by 30%.
  • Smoking – chronic coughing can occur with smoking thus increasing risk of leakage
  • Pulmonary diseases, allergies, and sinusitis – may increase coughing and sneezing
  • Caffeine and alcohol – excess use can lead to increase urine production and increased pressure on the bladder
  • Medication – such a diuretics increase urine production
  • Sports – especially running or tennis
  • Prostate surgery – in men, surgery on the prostate can lead to damage of the sphincter or nerve control of the urethra

What can be done about USI?
Therapy options are dependent on the severity of the symptoms and the impact on a person’s daily life.

  • Decrease use of caffeine and alcohol
  • Stop smoking
  • Keep a urinary diary – include how many times a day leakage occurs, if it occurs during the day or just in the evening, how often you have get up from sleep to urinate, and if you have to use protection and how often the protection has to be changed.
  • Control your fluid consumption – if the problem occurs more often in the evening, late afternoon and evening drinking may need to be decreased.
  • If overweight, attempt to lose weight
  • Bladder retraining – since bladder control is a learned response, it can be retrained. Schedule your voiding at least every couple of hours to attempt to reduce accidents.
  • Pelvic floor exercises – Kegel exercises (the tightening of the muscles that work to stop the flow of urine) have been shown to help with bladder control. The exercises should be done for ten to fifteen minutes at least twice daily. These can be done while doing other things like washing dishes or applying makeup. Within two months, most women who do the exercises regularly can see improvement.
  • Electrical stimulation – stimulation of the nerves that control the pelvic floor has been shown to help contract the muscles and gain control.
  • Medications – therapies may vary from estrogen creams, antidepressants, and medicines to help control the muscle actions.
  • Surgeries – may vary from bladder support to muscle repair. These may be done by a gynecologist or a urologist.

Being incontinent is not a normal part of getting older and not something that has to be tolerated. Talk to your physician treatment options that are available.

More about Dr. Aulds

Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.

Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.

Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.