Stress Urinary Incontinence
Stress urinary incontinence is the leakage of urine when you are doing something that causes an increase in abdominal pressure. For example, a cough, sneeze, running, jumping or lifting a weight.
The reason why stress urinary incontinence happens is multifactorial and complex.
Normally the urethra has a supportive layer made up of fascia and the deep pelvic floor muscles. If any of the structures supporting the urethra become damaged, e.g. during child birth, the urethra can move lower and not sit in its usual position. This will change the ability of pressures to transmit equally to the bladder and urethra in times of increased abdominal pressure e.g. cough, sneeze, lift, therefore increasing the chance of incontinence.
Other times there can be dysfunction of the urethral elements that result in reduced urethral closure pressure i.e. volume and structure of urethral muscle, nerve innervation, sphincter facilitation, vascular closure pressure, urethral wall structure and elasticity.
Most often than not it can be a combination of both elements that contribute to incontinence.
There are two main reasons that stress urinary incontinence commonly occurs:
1. Urethral support deficiency: Refers to structures that provide a supportive layer upon which the urethra rests e.g. anterior vagina, endopelvic fascia and levator ani (deep pelvic floor). If any of the structures supporting the urethra become damaged, e.g. during child birth, the urethra can move lower and not sit in its usual position. This will change the ability of pressures to transmit equally to the bladder and upper urethra in times of increased intra-abdominal pressure e.g. cough, sneeze, lift, therefore increasing the chance of SUI.
2. Intrinsic sphincter deficiency (ISD): The dysfunction of urethral elements that result in overall urethral closure pressure i.e. volume and structure of urethral muscle, nerve innervation, sphincter facilitation, vascular closure pressure, urethral wall structure and elasticity.
If any of the structures supporting the urethra become damaged, e.g. during child birth, the urethra can move lower and not sit in its usual position. This will change the ability of pressures to transmit equally to the bladder and upper urethra in times of increased intra-abdominal pressure e.g. cough, sneeze, lift.
Management of Stress Urinary Incontinence
There is good evidence that shows that pelvic floor physiotherapy can help with stress urinary incontinence and prolapse, and can lessen the effects of childbirth and menopause on the pelvic floor.
Pelvic floor muscle training. This includes release and retraining of the muscles with an emphasis on strength, endurance, coordination and ‘The Knack’.
Providing assistance in the management of weight loss, breathing mechanics, abdominal wall training, and transferring of loads during the specific task.
Advice on oestrogen replacement which can be discussed with your GP.
Supports of the urethra with the use of a silicone pessary.
Advice about exercise – what you can do and what to avoid.
Referring to gynaecologist, urogynaecologists and colorectal surgeons.
