Stress urinary incontinence: The embarrassing symptom

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Stress incontinence (SUI) is an involuntary sudden urine loss related with the increasing of intra-abdominal pressure. SUI extremely affects patient’s quality of life by making them lack self-confidence in social interacting because of the pungent smell of the urine deriving very closely to their noses. The patients will always come to Urology office accompanied with the complaining of urine leaking by these stimulating causes.

• Coughing
• Laughing
• Sneezing
• Straining from the exercise or lifting a heavy object

The etiologies of Stress incontinence can be divided into 2 major causes.

1. Pelvic floor muscle dysfunction – While the complex human pelvic floor muscle plays a major role in continence system, so anything which interfere their function in consequences it will causes Stress incontinence.
   • Obesity – Another function of pelvic floor is lifting all intra-abdominal contents such as intra-abdominal fat, intestine, liver and spleen so the more obesity, the heavier intra-abdominal contents are, and these will lead to an earlier overall dysfunction of pelvic floor muscle.
   • Menopause – Estrogen hormone play major role in nourishing female urethral blood flow so lacking estrogen will lead to lacking continence function of female urethra.
   • History of pregnancy – Like I mentioned in obesity, the history of pregnancy is a temporary period of time which pelvic has to lift more weight than usual. The greater number of pregnancies the more risk of Stress incontinence.
   • Pelvic floor trauma after normal delivery – The normal delivery is a method which the fetus is passed through the mother’s pelvic region and this leading to inevitable natural pelvic floor dysfunction especially pelvic floor trauma is reported.
   • Chronic cough and constipation – Any chronic repetitive increased intra-abdominal pressure will boost up the degeneration process of pelvic floor muscle.

2. Pelvic floor neuromuscular damaging from previous pelvic surgeries – Major intra-abdominal surgeries such as prostate cancer surgery can be resulted in postoperative Stress incontinence.

Stress incontinence is being reported and found more in female, around 15% in adult women complaint about the SUI, there’s only 60% in that have been seeking for a medical treatment. While patients visit at my office, a full history wills asking, a physical examination and the necessary laboratory test including imaging will be done to confirm the SUI’s diagnosis.

The treatment options will divide into 3 categories.

1. Habitual treatment
   • Kegel exercises – 3 sets of 10 pelvic muscle contractions held for 10 seconds 3 times a day regularly.
   • Voiding Schedule – Schedule a regular’s urination.
   • Pessaries – is recommended in case intravaginal anatomical distortion is observed during physical examination.

2. Medications
   • Anti-cholinergic can minimize bladder contraction.
   • Anti-depressant can boost up urethral contraction and closure.
   • Estrogen cream can nourish urethral mucosa which leading to improve continence function.

3. Surgical interventions
   • Urethral bulking agent injection
   • Mid-urethral sling procedure

The important messages that we would like to inform the SUI patients is that there’s no such a single management which is the best for every SUI patients like a tailor-designed, actually, it is the step-by-step management advisement and setting up a goal together with patients. If you got any questions, you could text me directly. Take care!