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Stress Incontinence

Overheard at a party: "Oh! God. Please don’t make me laugh. Every time you tell a joke, I dribble. It’s so embarrassing!"

Patient to Doctor: "Doctor, please do something about this cough. With every bout I dribble a few drops of urine and you know I am a teacher!"

DEFINITION

Dribbling of urine in women accompanying sudden increase in pressure in the abdomen, i.e. during coughing, sneezing or even laughing loudly.

SIGNS & SYMPTOMS

Uncontrolled loss of urine with lifting, sneezing, singing, coughing, laughing, crying or straining to pass stools.

WHY DOES IT OCCUR?

Shortening of the urethra and loss of the normal muscular support for the bladder and floor of the pelvis. These changes occur during pregnancy and after childbirth, particularly repeated childbirth. They may also occur as a natural consequence of aging.

WOMEN MORE AT RISK

  • Repeated childbirth.
  • Women over 50.
  • Obesity.
  • Chronic cough or constipation.

HOW TO PREVENT

  • Eat a normal, well-balanced diet and exercise regularly to build and maintain muscle strength.
  • Learn and practice specific exercises (see General Measures) after childbirth, before symptoms of stress incontinence begin.

DIAGNOSTIC MEASURES

  • Observation of symptoms.
  • History and examination by a doctor.
  • Urinalysis to establish whether symptoms are caused by urinary-tract infection or by stress incontinence.

POSSIBLE COMPLICATIONS

  • Complete loss of urinary control. This requires surgery
  • Recurrent Urinary-tract infections.
  • Social isolation due to embarrassment.

TREATMENT

If it is not severe enough to require surgery, exercise can improve the muscle function. If it is severe, it can be cured with surgery.

GENERAL MEASURES

Learn to recognize, control and develop the muscles of the pelvic floor. These are the ones you use to interrupt urination in mid-stream. The following exercises (Kegel exercises) strengthen these muscles so you can control or relax them completely:

  • To identify which muscles are involved, alternately start and stop urinating when using the toilet.
  • Practice tightening and releasing these muscles while sitting, standing, walking, driving, watching TV or listening to music.
  • Tighten the muscles a little at a time, "like squeezing a rubber ball with full force and then releasing it very slowly."
  • Tighten the muscles from front to back, including the anus, as in the previous exercise.
  • Exercise 3 times a day, every morning, afternoon and evening. Start with 5 times each, and gradually work up to 20 or 30 each time.

MEDICATION

Medicine usually are not necessary for this disorder, but you may be prescribed:

  • Antibiotics if you have a complicating urinary-tract infection.
  • A pessary made of rubber or other material to fit inside the vagina to support the uterus and lower muscular layer of the bladder.

ACTIVITY

No restrictions.

DIET

Lose weight if you are obese.

CONTACT YOUR DOCTOR IMMEDIATELY

  • You have typical symptoms of stress incontinence.
  • Signs of infection like fever, pain on passing urine, frequent urination or a general ill feeling develops.
  • Symptoms don't improve after 3 months of exercises or symptoms become intolerable and surgery is to be considered.
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