The Science Behind Stress Incontinence

Afflicting every third woman, this form of urine leakage can be caused by pregnancy, surgery or obesity. 

According to research nearly 50% women above the age of 65, and nearly one-in-three women suffer from stress incontinence at some point in their life. 

Found more commonly in women than men this type of urine leakage is often caused after pregnancy, due to obesity and ageing. 

Different from psychological stress, incontinence stress is said to occur when physical stressors such as sneezing, running, coughing, laughing, bending or heavy-lifting results in small amounts of urine being squeeze out. 

Stress urinary incontinence can be a source of embarrassment for women across ages. Whether you are an overweight woman in your early 20s at a barbecue; or a young mother at playdate—the little damp spot on your dress or shorts can be both an embarrassment and leave a stain. Several women suffering from genuine stress urinary incontinence, thus, use adult diapers, elderly diapers or insert pads to deal with the urine leakage. 

The Workings of Stress Incontinence

The urinary tract consists of two kidneys, a bladder, a urethra and a bunch of muscles called the sphincter. All of this is supported and held in place by a hammock of muscles called the pelvic floor. 

The kidneys remove waste and excess water from our blood through the production of urine. This urine drains out of the kidney into the bladder through tubes called ureters. The balloon-like bladder stores urine. The mouth of the bladder is connected to a tube called the urethra the opening of which is controlled by sphincter muscles. When one is ready to urinate, the sphincter muscles relax and urine is expelled out of the body through the urethra. 

Now, the malfunction of mainly two parts of this process can be a cause of stress urinary incontinence.

• First, the weakening of the pelvic floor muscles, causing the entire system to droop.
• Second, weakening of the sphincter muscles at the neck of the bladder, resulting in the urethra remaining partially open.

As a result of this, any pressure exerted on the pelvic floor or abdominal region results in the leakage of urine.

What causes such situations? Let us see.

Causes of Stress Urinary Incontinence

Stress urinary incontinence may be caused by:

• CHILDBIRTH: Tissue or nerve damage caused due to the delivery of a child can weaken pelvic floor muscles or the urinary sphincter. This is especially common in vaginal deliveries, where forceps may be inserted inside the vagina to assist the delivery.
• PROSTATE SURGEY: In men, prostate cancer, which involves prostatectomy or the surgical removal of the prostate can lead to stress incontinence. This surgery can result in the weakening of the sphincter which encircles the urethra directly below the prostate gland.
• OBESITY: Excess fat can exert pressure on the pelvic floor and cause stress incontinence. 

• OTHER: Other causes of stress urinary incontinence can include illnesses that cause chronic coughing; smoking, practicing high-impact activities over several years and injuries to the lower back.

With mild stress urinary incontinence, pressure from sudden forceful activities like exercise, sneezing or coughing may cause leakage. However, with severe stress urinary incontinence, this may even be caused by less forceful activities such as bending, standing up or walking.

Stress Incontinence versus Overactive Bladder

A lot of people confuse Stress Incontinence with Overactive Bladder, however the two are entirely different. Overactive Bladder or Urge Incontinence is characterised by frequent, strong urges to urinate. Sometimes this sudden urge is accompanied by actual urine leakage. Stress Urinary Incontinence is primarily a urethral problem where the urethra is unable to stop the increase in pressure. Overactive Bladder, meanwhile, is a bladder problem where the bladder muscles spasm and squeeze uncontrollably.

Some people have both types of incontinence. This is called Mixed incontinence. Read more about mixed, urge and stress incontinence here. 

Living with incontinence can be tough. Many people feel hopeless and isolated. It can affect work, family and sexual relationships. However, with the right management and treatment incontinence stress can be easily taken care of.

1. EXERCISE:

The Kegel exercise for stress incontinence has huge impact in helping women deal with urine leakage post pregnancy. A simple form of physical therapy that involves clutching and holding the muscles around the vagina and pelvis, this helps the body tone and strengthen up weakness in the area. Practising this for about 30 reps for about 6 months after a pregnancy can speed up recovery.

“After my second child, I faced incontinence,” said Parul Makwana (34). “The doctor recommended I wear a belt and do kegels every day. In the beginning the exercise was very difficult. Every time I clenched the muscles there, I wanted to pee. So I started wearing elderly diapers to stop the leakage. But as time went by, I got used to it, could do more reps and didn’t need the diapers!”

2. BLADDER TRAINING:

Kegel exercises combined with bladder training can make for the perfect physical therapy for stress incontinence. Post-surgery and -pregnancies the body needs to be retaught how to hold urine and go only on urge. In bladder training, the patient is asked to hold their urine and use the toilet only at specifically controlled intervals. As time goes by, the intervals are slowly increased. While Kegel exercises for stress incontinence help shape the muscles, bladder training helps the mind adapt. 

3. SURGERY:

The surgical treatment of stress urinary incontinence is also possible. This mainly has three types:

1. 1. Retropubic suspension: In this type of procedure the neck of the bladder is attached to the pubic bone through an incision in the abdomen. 
   2. Sling Operation: In the sling operation for stress incontinence a sling made of natural tissue or synthetic material is used to physically prop up the urethra. The sling goes around the urethra and is usually attached to the public bone.
   3. Artificial sphincters: Commonly used for men, in this a fluid filled insertion is placed around the urethra. This functions as a valve to contain the urine that would have otherwise leaked and can be opened and closed by the patient.

4. PESSARIES:

Pessaries for stress incontinence are small rings which are inserted into the vagina and can help keep the urethra in its place. Speaking about the use of pessaries a patient who preferred not to be named said, “The ring inside my vagina helped put pressure on the urethra. So urine leakage stopped. But I faced weird, while vaginal discharge and eventually got an infection. So, be very careful!”

5. DIAPERS:

Elderly diapers, or sleek ones customised for women, can provide a great temporary solution to issues caused by incontinence stress or overactive bladder. “I started using diapers that the hospital gave me post prostate surgery,” said Hemang Bhattacharya (55) from Bombay. “When I went home my wife asked the chemist and they recommended Friends Adult Diapers. We have been using that ever since. The diapers are soft, anti-bacterial and easy to throw. I wear them to office and parties. They don’t make the rustling sound I was scared of and come in pant-style, which remains discreet. I am now getting better. Hope to be fine soon!”

To conclude, remember that the best treatment for stress incontinence or any form of urine leakage is to keep a positive outlook and move onwards with the help and support of friends and family. One will always have operative and physical solutions, but nothing can replace belief in oneself. ☺