Stress incontinence is very uncomfortable for those affected. Although the involuntarily leaking urine can be caught with hygienic pads, it affects the patient’s quality of life. You can no longer move as freely as before.
What is stress incontinence?
Stress incontinence is called stress incontinence in modern medicine. What is meant by this is the physical strain on the bladder sphincter. Stress incontinence is associated with the involuntary leakage of urine due to increased pressure in the lower abdomen. Patients leak urine when they sneeze or climb stairs. For what is the definition of intercostal neuralgia, please visit healthknowing.com.
The patients – most of those affected by this form of incontinence are female – do not feel the urge to urinate beforehand. Depending on the severity of the disease, medicine distinguishes between three different degrees. Coughing, laughing, sneezing and jumping are considered severe physical stress (grade 1). Standing up, sitting down, climbing stairs and walking are considered mild physical exertion leading to involuntary urine loss (grade 2).
If the urine comes out at rest, for example when lying down on the sofa, this is grade 3 of stress incontinence. With 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 older patients more than younger ones. To prevent soiling of underwear, other textiles and the living environment, patients use incontinence pads.
Causes
Stress incontinence can have a variety of causes. It often goes back to a constitutionally conditioned or acquired pelvic floor weakness. The patients have genetically weak connective tissue or it was caused by pregnancies and natural births. A congenital malformation or acquired damage to the bladder sphincter can also lead to stress incontinence.
In female patients, prolapse of the uterus and vagina and removal of the uterus also lead to incontinence. Other causes in men and women are: severe obesity, heavy physical work, chronic bronchitis, cystitis, nerve damage in the area of the urinary bladder and prostate carcinoma.
However, women who give birth to their children naturally do not have to worry about having to endure the involuntary loss of urine that occurs during pregnancy for the rest of their lives: only around six percent suffer from stress incontinence afterwards. In men, involuntary leakage of urine often occurs after a prostate removal.
Symptoms, Ailments & Signs
Stress incontinence manifests itself as the loss of smaller and larger amounts of urine. In the case of more severe stress incontinence, the urine is released even in patients who are at rest and in those who are hardly physically active. The uncontrolled loss of urine is not associated with pain, but it is extremely uncomfortable for those affected. They fear that people nearby will notice that they have wet themselves.
Diagnosis & course of disease
The doctor treating you first takes a detailed medical history. In order 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 region, and neurological tests should provide further information about the stress incontinence present.
If there is definitely a bladder dysfunction, the further procedure of the doctor depends on the extent of the stress incontinence. Imaging methods ( ultrasound, CT), cytoscopies, urethral calibration, and blood tests are used. A micturition log over the last two days before the medical examination should provide further information.
Complications
Stress incontinence can cause various complications. The unintentional loss of urine primarily affects the psyche of those affected, who often develop fears and withdraw from social life. Long-lasting symptoms in particular therefore represent a great psychological burden for the sufferer. In extreme cases, pronounced anxiety disorders, inferiority complexes or depression develop.
A possible physical effect of stress incontinence is inflammation in the intimate area. Especially when there is a lack of hygiene, urine is the basis for bacterial diseases and symptoms such as itching, redness and abscesses. Adverse events can also occur during treatment. Taking medication is occasionally associated with side effects and interactions. Typical symptoms are hypersensitivity reactions, gastrointestinal problems and shortness of breath.
During pelvic floor training, there is a risk of germs getting into the vagina and leading to urinary tract infections. Pressure sores can also develop. In extreme cases, electroshock therapy can lead to neurological symptoms or cardiac arrhythmia. Biofeedback also entails risks: In the case of existing mental illnesses, the procedure can cause serious complications and sometimes aggravate the underlying condition. Finally, bleeding and wound healing disorders can occur during an operation.
When should you go to the doctor?
People who suffer from a persistent experience of stress should always consult a doctor or therapist. Constant stress leads to various health disorders that must be counteracted in good time. If the person concerned also suffers from an unintentional loss of urine, there is a need for action. If psychological problems arise as a result of the irregularities, a doctor is required. Shame, withdrawal from social life, or anxiety are signs of an irregularity. They indicate problems that should be investigated.
A reduced quality of life or reduced well-being lead to various diseases in the long term. If symptoms persist for several weeks or months, a doctor should therefore be consulted. If there is an unintentional loss of urine when coughing, laughing, moving around or sneezing, a doctor must be informed of the observations. Fatigue, sleep disturbances or bedwetting at night are other signs that should be examined.
Research into the cause is necessary so that a diagnosis can be made and a treatment plan can be drawn up. If the impairments lead to an occupational disability or interpersonal problems, the person concerned needs help. Personality changes, abnormal behavior or listlessness are considered warning signs that should be followed up. In many cases, those affected are not aware of the stress triggers they are exposed to on a daily basis. They need support for clarification and awareness.
Treatment & Therapy
Treatment is conservative or surgical, depending on the severity of the disease. Proven conservative methods include pelvic floor training, biofeedback, electrical stimulation, use of a pessary, taking medication and combination therapies (medication-physiotherapeutic).
In pelvic floor exercises, after initial instruction from the physiotherapist, the patient performs a variety of simple exercises that strengthen the muscles and ligaments of the musculoskeletal system. He learns to consciously use them in everyday life as needed. With biofeedback, he also receives a visual and acoustic reaction if he carries out the given exercises correctly.
This technique can also be usefully supplemented by other methods and equipment such as electrostimulation and the magnetic chair. With electrostimulation, the sphincter muscle is not tensed by the patient himself, but is stimulated by electrodes inserted into the anus or vagina. Inserting a pessary into the vagina is only suitable for women. It elevates bladder neck or uterus.
Pulling activates the sphincter muscle and lifts the urethra and bladder muscle. Treatment is with estrogen administration or prescription of a selective serotonin-norepinephrine reuptake inhibitor (SSNRI). For example, duloxetine causes an increased release of neurotransmitters. Also only suitable for women are Feminakonen, tampon-like shaped weights of different weights that are inserted into the vagina and train the pelvic floor.
If the stress incontinence requires surgical treatment, the choice of surgical method depends on whether the descent of the uterus or the stress incontinence is more urgent. If the involuntary urination causes more problems, a stabilizing plastic band (TOT, TVT) is inserted. If there is muscle weakness in the pelvic floor area, a vaginal perineum plastic surgery is performed.
In the case of very severe stress incontinence, only the insertion of an artificial sphincter (AMS sphincter, Pro-ACT) helps. Implacement therapy is innovative: the minimally invasive procedure involves lining the urethral tissue with microparticles that are in a hyaluronic acid matrix.
Prevention
As a preventive measure, drinking plenty of fluids throughout the day is recommended. It trains the bladder sphincter. In addition, preventive floor pool gymnastics (for both sexes!) has proven to be very effective. Under no circumstances should the patient reduce their daily fluid intake, otherwise the capacity of their 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 disease, the chosen therapy and the respective success of the treatment. After an operation, several check-ups are necessary.
Above all, the healing of the surgical wound is monitored. As a rule, the wound must be treated for a few weeks. Healing is accelerated by daily application of an ointment. Uncomfortable itching often occurs. For this reason, repeated sitz baths are often recommended. In general, strict personal hygiene must be observed.
Bandages should be changed daily. Depending on the underlying disease, various other measures are also required. In many cases, despite initially successful treatment, relapses occur again. Therefore, regular check-ups by a general practitioner or, depending on the cause of the stress incontinence, by a urologist, gynecologist or another specialist are necessary.
Those affected should also seek advice from specialists in ostomy care. In order to deal better with the disease in everyday life, they should familiarize themselves with the use of incontinence equipment such as adult diapers or pads. Since stress incontinence usually represents a major psychological burden, long-term psychotherapeutic care is often necessary.
You can do that yourself
There are a few things people with stress urinary incontinence can do to help relieve the symptoms. Incontinence aids such as panties, disposable panties or anal tampons make everyday life with the disease easier. An incontinence product should be used, especially in stressful life situations.
Regular use of the toilet is just as important. Excessive urination can cause the bladder to get used to it and increase the urge to urinate. Very infrequent urination, on the other hand, can lead to overstretching of the bladder muscles. If you are overweight at the same time, this must be reduced. Obesity leads to high pressure in the abdominal cavity and increases incontinence. Since the incontinence leads to a greater bacterial load on the skin, careful personal hygiene should be ensured. In particular, the intimate area must be sufficiently cleaned.
If you also eat a bladder-friendly diet by avoiding black spices or coffee, the stress incontinence should noticeably decrease after a few days. However, the trigger for the complaints must also be eliminated. It is important to reduce stress factors in everyday life and at work and to create additional peace and balance through relaxation exercises such as autogenic training.
