What is Stress Urinary Incontinence?
Stress Incontinence is the leaking of small amounts of urine during activities that increase pressure inside the abdomen and push down on the bladder. Stress incontinence is most common with activities such as coughing, sneezing, laughing, walking, lifting, or playing sport. Stress incontinence occurs mainly in women but can occur in men especially after prostate surgery. An Australian study found that over a three-month period, 50% of women aged 45-59 years of age experienced some degree of mild, moderate or severe urinary incontinence.2
Stress urinary incontinence (SUI) is the most prevalent type of urinary incontinence3, also known as effort incontinence, is due essentially to insufficient strength of the pelvic floor muscles and caused by loss of support of the urethra. It’s almost always a result of an underlying and treatable medical condition but is underreported to medical practitioners.3
As many as 4 in 10 women suffer with urinary incontinence during pregnancy4. During pregnancy, your baby grows and pushes down on your bladder, urethra, and pelvic floor muscles. Over time, this pressure may weaken the pelvic floor muscles and lead to leaks or problems passing urine.
Possible Causes of Stress Incontinence
Stress incontinence in women is often as a result of pregnancy, childbirth and menopause. Pregnancy and childbirth often stretch and weaken the pelvic floor muscles that support the bladder and urethra causing stress incontinence during activities that push down on the bladder. This can also be caused by a traumatic vaginal delivery.
Following childbirth women’s abdominal muscles are often weak or separated. If these muscles are not healed over time it puts a lot of stress on the back and pelvic floor muscle causing low back pain and weakened pelvic floor muscles. To understand this, imagine your abdomen and back are 2 sides of a rectangle and the top is your diaphragm and the bottom your pelvic floor. If any one of the sides of the rectangle are weakened the whole rectangle may collapse or have adverse effects on the other sides of the rectangle, which is effectively your core.
It can also happen to women who have not had children and some studies show this to be one in five women over 45 years experiencing this type of incontinence.1
During menopause, the hormone oestrogen is produced in lower quantities. With less oestrogen, women can experience stress incontinence during menopause because one of its functions is to maintain the thickness of the urethra lining to keep the urethra sealed after passing urine.
Other factors contributing to stress incontinence include diabetes, chronic cough (linked with asthma, smoking or bronchitis), constipation and obesity.
What should you do if you have Stress Incontinence?
Most problems with bladder control during pregnancy go away after childbirth when the muscles have had some time to heal. Problems during labor and childbirth, especially vaginal birth, can weaken pelvic floor muscles and damage the nerves that control the bladder. Most problems with bladder control and continence that happen as a result of labor and delivery go away after the muscles have had some time to heal. If you’re still having stress incontinence issues 6 weeks postpartum, talk to your doctor, physio or midwife.
There are several health practitioners that can help you if experiencing Stress incontinence, however these are the top 5;
- General practitioners (GP) can assess, diagnose and treat incontinence. They have varying levels of knowledge and experience with incontinence. Some may choose to refer you to a continence health professional rather than diagnose and treat your condition. In many cases it is important to involve your GP in your continence care as they have good knowledge of your health history, including any medical conditions, surgery or medications you may be on, which may increase your chances of developing continence issues.
- Urologists have the combination of medical and surgical training who treat men and women with kidney, bladder and urinary problems.
- Gynaecologists specialise in preventing and treating illnesses of the female reproductive organs. If you are incontinent, your general practitioner may refer you to a gynaecologist for urinary incontinence treatment.
- Urogynaecologists are gynaecologist who have undertaken further advanced specialist training to deal with the complexities of vaginal prolapse and types of bladder dysfunction including urinary incontinence.
- Womens Health Physiotherapists who specialise in pelvic floor health and hold post graduate qualifications specializing in pelvic floor muscle training. They can assess your pelvic floor function and tailor an exercise program to meet your specific needs. They can also discuss relevant lifestyle factors with you. Many other physiotherapists have an interest in women’s health and/ or pelvic floor and do not hold post graduate qualifications but may work exclusively in this area and be a great source of help.
With the help of your health care professional you will be able to ascertain the STAGE of your urinary incontinence:
- Stage I – Light, urine loss quantity maximally until 10 g (10 mls)/24 hour
- Stage II – Moderate, urine loss quantity of 11 to 50 g (11-50 mls)/24 hour
- Stage III – Heavy, urine loss quantity over 50 g (50+ mls)/24 hour
The earlier you can address the problem the easier it will be to treat, so please don’t put it off.
Your health care professional is likely to suggest some things you can do at home to help treat urinary incontinence. Many women do not think that such simple actions can treat urinary incontinence. But for many these somewhat simple steps make urinary incontinence go away entirely or, at the least, help with the severity of urinary stress incontinence. These steps may include:
- Pelvic floor exercises- If you have stress incontinence, pelvic floor exercises to strengthen your pelvic floor muscles may help. Kegel exercises work differently for each person. It may take 4 to 6 weeks before you notice any improvement in your symptoms. Your symptoms may go away totally, you may notice an improvement in your symptoms but still have some leakage, or you may not see any improvement at all. But even if your symptoms don’t get better, exercises can help prevent your incontinence from getting worse. You may need to continue doing pelvic floor exercises for the rest of your life. Even if your symptoms improve, urinary incontinence can come back if you stop doing the exercises.
- There is a right way to perform pelvic floor exercises so please make sure you are doing them correctly. There are plenty of devices that can help you make sure you are doing the right thing. You also have to be aware that some women have urinary symptoms because the pelvic floor muscles are over-working, not under-working. In this situation, exercises will not help your urinary symptoms and may cause more problems, so please talk to your doctor or physio about your urinary symptoms and get the absolute best advice.
- Compression Garments- Another way of activating your pelvic floor and potentially decreasing your urinary incontinence is trying a revolutionary new compression underwear product specifically designed and tested for this – SRC Restore. These garments increase the biofeedback and help the pelvic floor activity and can significantly reduce the symptom of stress incontinence and restore quality of life
- Losing weight- Extra weight puts more pressure on your bladder and nearby muscles, which can lead to problems with bladder control. If you are overweight, your chosen health care professional can help you create a plan to lose weight by choosing healthy foods and getting regular physical activity.
- Changing your drinking choices- Drinks with caffeine, carbonation (such as sodas), or alcohol may make bladder leakage or urinary incontinence worse. Your doctor might suggest that you stop drinking these drinks for a while to see if that helps.
- Quitting smoking- Smoking can make many health problems, including urinary incontinence, worse.
- Treating constipation- Your doctor might recommend that you eat more fibre, since constipation can make urinary incontinence worse. Eating foods with a lot of fibre can make you less constipated.
- Use pads or protective underwear- These are sold in many stores that also sell feminine hygiene products like tampons and pads. Although it is a band-aid solution it will make everyday life a lot more comfortable and less stressful while you take other steps to treat urinary incontinence.
The most important aspect of managing stress urinary incontinence is improving the function of your pelvic floor. Most women have heard about it and know the basics about the importance and function of their pelvic floor, yet few take Pelvic Floor exercise seriously. Please consult your doctor or physio to get the right diagnosis for your dysfunction followed by a “tailored to you” exercise program for your pelvic floor.
- Sangsawang, B., & Sangsawang, N. (2013). Stress Urinary Incontinence in Pregnant Women: A Review of Prevalence, Pathophysiology, and Treatment. International Urogynecology Journal; 24(6): 901–