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Stress incontinence (bladder leak when sneezing, coughing or exercising) is a very common complaint I hear from my patients.

What is stress incontinence?

Stress urinary incontinence (SUI) is defined by the International Continence Society (ICS) as “the complaint of any involuntary loss of urine on effort or physical exertion (e.g. sporting activities) or on sneezing or coughing”.

Stress incontinence is the type of involuntary loss of urine that happens during physical movement (for instance running, heavy lifting or jumping on a trampoline) or activities that elevate the intra-abdominal pressure (stress) on the bladder (such as sneezing, couching, laughing). It is more common in women of young to middle age. Stress incontinence is uncommon in men who have not had prostate surgery.

Many reasons could account for this gender difference:

  • dissimilarities in the anatomy of the pelvic floor
  • the effect of pregnancy and delivery
  • the role of hormones
  • genetics

What causes you to have stress incontinence?

Pelvic floor muscle strength decreases after childbirth (between 15-30% of first time mums will experience bladder leaks). It can return to the normal range few weeks later, however in many women the weakness persists. Postpartum incontinence is linked to several parameters:

  • forceps use
  • duration of labour
  • number of deliveries
  • epidural analgesia
  • episiotomy
  • pre-existing bladder neck mobility

In nulliparous women, strenuous exercise and ageing seem be the most common factors for developing stress urinary incontinence.

There are two concepts that are considered to be the main causes of SUI: urethral hypermobility (the loss of urethral support) and intrinsic sphincter deficiency (poor closure).

How is stress urinary incontinence diagnosed?

Stress urinary incontinence is diagnosed based on thorough subjective assessment (we would ask you several questions about your symptoms, obstetric history, bladder and bowel habits). Transperineal ultrasound is often used to evaluate the mobility of the bladder neck and proximal urethra (you can watch it here. Attention is paid to the posterior urethrovesical angle, which at rest is 110-120 degrees. When this angle is larger, there is a loss of urine, an increase in this angle can be seen with pelvic organ prolapse. We will also assess your pelvic floor muscle function through internal vaginal exam.

How is stress urinary incontinence treated?

As pelvic floor weakness has been observed in women with SUI, pelvic floor training is the first choice of treatment for it. Conservative treatment should always be exhausted before considering any surgical intervention. Make sure to watch this interview where Dr Galimberti chats with Dr Suzanne O ‘Sullivan on the pros and cons of new treatments for urinary incontinence.

What does the pelvic floor training involve?

Before you start the training, it is essential to know how to do the pelvic floor exercises correctly. As many women struggle with the correct muscle activation, it might be necessary to visit women`s health physiotherapist for an assessment.

Pelvic floor muscle training (PFMT) involves:

  • learning ”The Knack” (conscious contraction of the PFM before and during an increase in intra-abdominal pressure such as sneezing, coughing, lifting)
  • regular PFMT to build structural support of the pelvic floor
  • training of the internal abdominal muscles (often referred to as the ”core”), especially the transversus abdominal (TrA) muscle
  • functional training of the PFM (performing the contraction during different tasks of daily activities)
  • biofeedback as an adjunct to treatment and to enhance the effect of the training program

Remember, you are not alone. Bladder leaks are common, but not normal. Stress urinary incontinence can be treated and it is nothing to be embarrassed about. You can book your pelvic floor assessment here

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