Urogynaecology Stress Incontinence (SI)

Stress incontinence (SI) is the most common form of incontinence in young women. It means you leak urine when you increase the pressure within the abdominal cavity, as in coughing, sneezing or exercise. It happens when the pelvic floor muscles that support the bladder are weakened. Childbirth is a common reason for a weak pelvic floor. The main treatment for stress incontinence is pelvic floor exercises. Surgery to tighten or support the bladder outlet can also help. Medication may be used in addition to exercises if you do not want, or are not suitable for, surgery.

What is stress incontinence?

Stress incontinence occurs when urine leaks because there is a sudden extra pressure within the tummy (abdomen) and on the bladder. This pressure (or stress) is caused by things like coughing, laughing, sneezing or exercising (such as running or jumping). Weakened pelvic floor muscles cannot support the bladder and urine outlet (urethra) as well as they should. The pressure is too much for the bladder outlet to withstand and so urine leaks out. Small amounts of urine may leak but sometimes it can be quite a lot and can cause embarrassment.

How common is stress incontinence?

  • Stress incontinence is the most common form of urinary incontinence. It is estimated that over 3.3 million women in the UK and Ireland are regularly incontinent. Overall this is about 4 in 100 adults, and well over half of these are due to stress incontinence. Stress incontinence becomes more common in older women. As many as 1 in 5 women over the age of 40 have some degree of stress incontinence.
  • It is likely that the true number of people affected is much higher. Many people do not tell their doctor about their incontinence, due to embarrassment. Some people wrongly think that incontinence is a normal part of ageing or that it cannot be treated. This is unfortunate, as many cases can be successfully treated or significantly improved.

What causes stress incontinence?

Most cases of stress incontinence are due to weakened pelvic floor muscles. Pelvic floor muscles are often weakened by childbirth. The pelvic floor muscles are a group of muscles that wrap around the underside of the bladder and back passage (rectum). Stress incontinence is common in women who have had children. It is also more common with increasing age, as the muscles become weaker, particularly after the menopause. Stress incontinence is also more common in women who are overweight.

What are the treatment options for stress incontinence?

First-line treatment involves strengthening the pelvic floor muscles with pelvic floor exercises. About 6 in 10 cases of stress incontinence can be cured or much improved with this treatment. If you are overweight and incontinent then you should first try to lose weight in conjunction with any other treatments. Surgery may be offered if the problem continues and is a significant problem. Medication may be used in addition to exercises if you do not want, or are not suitable for, surgery. Pelvic exercises are best taught by either physiotherapists or nurses who have specialised in the pelvic area. They will examine a woman vaginally and assess the pelvic floor muscles and give them a grading (oxford) score. If they find the oxford score is very good it is unlikely that the SI will improve with physiotherapy, this may also be the case if the oxford score is very low as this might imply underlying pelvic floor muscle or nerve damage. Those women who lie in-between these extremes may well respond to this treatment.

Local recommended physiotherapists are:

Bernie Leamy at http: http://www.physio4women.ie/index.php/contact/

Linda Williams at www.kilkennyphysioclinic.com

Laura Carroll at www.livewellwaterford.ie 

Surgery

  • Various surgical operations are used to treat stress incontinence. They tend only to be used when the pelvic floor muscle exercises have not helped. The operations aim to tighten or support the muscles and structures below the bladder.
  • The retropublic tension-free vaginal tape  procedure is the name of an operation often used to treat stress incontinence. It involves a sling of  (with non polypropylene mesh) tape being used to support the urethra and bladder neck.
  • A Colposuspension is the name of another operation to support the urethra and treat stress incontinence that was performed prior to the introduction of the TVT.
  • In general, surgery for stress incontinence is often successful.