STRESS URINARY INCONTINENCE (SUI)

22/04/2020

Bladder is an organ which contains the urine produced by the kidneys. Its function is holding the urine until you are ready to release it out (urination).

When your bladder works well:

You can urinate or hold your urine continently when you have a demand, without worrying about leaking urine (urinary incontinence).
You can go to school, working, shopping, taking a long road trip, exercising or watching movie without worries of leaking the urine.
The average frequency of urination in 24 hours is 6- 8 times (not over than once in the night time)
You can hold your urine for delaying your urination until a proper time without leaking it.

Urinary incontinence is the urine leakage causing by a self control disorder of the bladder or the urethral sphincter muscle. It can occur in women, men and children and makes them afraid of being too far from a bathroom. SUI is more common in women. About 1 in 3 women has this problem at some point in their lives. Men may have the urine leakage after surgery or injury.

There are several ways to control and treat urinary incontinence. You can best control your urinary incontinence symptoms by yourself . Once knowing what to look for and what to expect for helping you manage your symptoms.

What is Stress Urinary Incontinence (urine leakage)?

Urinary incontinence is a situation when the urine leaks out without patient’s control. There are two types of urinary incontinence

Stress Urinary Incontinence or urine leakage: occurs when the bladder and the urethra (voiding tube) cannot control a sudden pressure increase. A mild to moderate amount of urine is released out without controlling. This sudden pressure increase may be from sudden forceful activities such as exercising, coughing, sneezing or laughing…
Urge Urinary Incontinence (UUI) in people with overactive bladder (OAB): arises suddenly, uncontrollable need to urinate. Leaking urine amount may be moderate to large amount, can cause frequent trips to the bathroom and getting up more than once at night to go to the bathroom.
The difference between SUI and OAB is due to anatomical structure. OAB is a bladder problem caused by uncontrolled bladder contraction and dilatation.

Many patients might have both SUI and OAB which are called "Mixed Urinary Incontinence".

Stress urinary incontinence occurs when there is sudden pressure increase on the bladder and the urethra causing the sphincter muscle to open briefly. This issue is more prevalent in women than in men.

Moderate SUI: while doing forceful activities such as exercising, sneezing, laughing or coughing.
Severe SUI: leak with less forceful activities (standing up, walking or bending over). The leaking urine amount can be a few drops or enough to soak through your clothes.

What causes SUI?

The most common risk factors are:

Gender: occurs more prevalent in females
Pregnant and breastfeeding women
Nerve injuries to the lower back (neurological bladder)
Pelvic or prostatic surgery
Chronic coughing
Smoking (which leads to chronic cough)
Overweight

Front of the bladder (left): the pelvic muscle is weak and causing urine leakage .

Signs and symptoms of SUI

To know whether you have this problem, ask yourself:

Am I afraid to be too far away from the toilet or changing room?
Have I stopped playing sports or exercising?
Have I changed my lifestyle because I am afraid of urine leakage?
Do I feel uncomfortable with myself and my body?
Have my symptoms changed my relationships with friends or family?
Am I avoiding sexual intercourse because I am worried that I will leak urine and be embarrassed?

If you answer yes to some of these questions, you should know that there is hope. Please visit and consult with an urologist for a diagnosis and an appropriate treatment.

Diagnosis

It is a confidential issue, sometimes is not easy to talk about. Therefore, keeping a bladder diary will be helpful before visiting your doctor.

A bladder diary is a tool used to:

Track your oral fluid intake in time, your urine volume and urination frequency in a day.
Track the time when you have urine leaks and what may cause these issues over a period of time

You and your doctor review together the bladder diary, these information will give your doctor the clues about what happening to you. He/ she will ask you some questions to make a diagnosis. Past and medical histories combined with a physical exam and subclinical tests will help to find causes of urinary incontinence.

Some subclinical tests that your physicians may order, including:

Urinalysis and urine culture to rule out urinary tract infection
Bladder scan to measure remaining amount of urine in your bladder after urinating ( post voided residual urine volume)
Cystoscopy to detect urinary tract pathologies. .
Urodynamic studies are indicated to show how well the bladder and urethral sphincters work in holding and releasing the urine, thereby can identify causes and whether a surgical intervention is needed to treat urinary incontinence?

Treatment

Not every treatments are effective for everyone. You need to consult with your doctor to determine the best treatment.

Medical treatment

You should:

Lifestyle changes: lose weight, stop smoking and maintain good overall health
Bladder training: It may be helpful to apply a schedule for going to bathroom (set time)
Pelvic floor muscle exercise ( Kegels exercises): to strengthen your pelvic floor muscle , support the bladder, sphincters and other organs in iliac region in order to prevent urinary incontinence. It’s important to do these exercises correctly and often.

Mechanical supporting devices are usually used in female patients.

Medicines: reduce urine leaks from an overactive bladder.

Surgery