Sneeze Leaks! Otherwise known as Urinary Stress Incontinence – Help!Urinary stress incontinence is the most common form of urinary incontinence in women and is associated with high financial, social, and emotional costs yet the majority of women who are experiencing this problem never discuss it with their health care practitioner. This is surprising, I thought we women talked about everything!
Urinary stress incontinence (USI) is defined as involuntary leakage of urine on exertion such as coughing, sneezing, laughing or exercising. Urinary stress incontinence affects approximately 13 million people in the United States alone and is much more prevalent in women than in men. Overall, 30% of women will develop USI within 5 years after their first vaginal delivery.
USI is associated with considerable social and financial costs. The social costs include personal embarrassment and curtailment of daily activities that may cause urine leakage. USI is associated with depression, particularly in the elderly and in people with an urge component.
The annual financial cost associated with urinary incontinence in the United States was estimated to be 16.3 billion dollars in 1995. The cost of incontinence pads and undergarments are borne directly by patients as they are usually not covered by health insurance plans. This is depressing.
Despite its frequency and potential significant impact on quality of life, women often under report urinary stress incontinence. They may be embarrassed, they may consider incontinence a normal part of aging, they may fear surgery, or they may not know about medical management options.
Urinary stress incontinence is the most common type of urinary incontinence in women.
Urge incontinence or “overactive bladder,” is the second most common type of urinary stress incontinence with many women experiencing both components. In most cases, the history and physical examination can identify patients with a significant stress component without the need for urodynamic testing. This is specialized testing performed by an urogynecologist or urologist specializing in gynecology issues.
Currently treatment in the United States is limited to various types of behavioral interventions, (Kegel exercises) mechanical devices, (pessaries) and surgery. However, pharmacologic treatment options (drugs and medications) are being investigated and becoming more widely available throughout the European Union and several other countries.
Risk Factors for Urinary Stress Incontinence
There are many factors that may contribute to this condition. The following are just a few:
- Estrogen depletion (menopause)
- Morbid obesity
- High – impact physical activities
- Pelvic muscle weakness
- Pregnancy/vaginal delivery/episiotomy
- Medications and other agents such as diuretics, caffeine, alcohol
Management of urinary stress incontinence with or without an urge component falls into the falling general categories:
Behavioral therapy includes bladder retraining and biofeedback, particularly with those with overactive bladder. Pelvic floor muscle exercises (kegel exercises) are used to rehabilitate and strengthen the pelvic floor muscles and promote urine storage.
Nonsurgical mechanical treatments include pessaries to elevate the vescio-urethral angle. If behavioral and pharmacologic treatments fail, surgical therapy is possible. A very popular surgical option is called Suburethral sling (“tension-free vaginal tape”) this option is gaining in popularity because of its short healing time and non-invasive approach.
A medication used more frequently is topical estrogen placed inside the vagina to build up the vaginal tissue. Without the appropriate amount of estrogen in the vagina the tissue can become very thin, easily irritated and frequent infections can occur. This condition is called atrophic vaginitis.
More recently a new selective serotonin and norepinephrine reuptake inhibitor, duloxetine, has demonstrated efficacy in phase 2 and 3 trials and has been approved throughout Europe. It has not yet been approved in the United States.
Lastly periurethral injections of bovine collagen or carbon-coated beads are available as a treatment option.
The most important take home message is that women do not need to suffer with this condition. It is important to report any incontinence to your health care provider and discuss treatment options that best suit your situation. Your day to day quality of life is important to your over all health and well being and you do not have to suffer in silence.