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Diagnosing Stress Incontinence Treatment options for Stress Incontinence Special concerns

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Stress Incontinence  - The Urology Channel

Many urologists classify stress incontinence by a three-category system:

Type I is stress incontinence in which the bladder neck and urethra are open and slightly hypermobile (too moveable), and the urethra descends (moves down) less than 2 cm during stress (that is, the angle of the urethra is nearly unchanged). Type I patients also have little or no sign of cystocele (dropped bladder).

Type II refers to stress incontinence in which the bladder neck and urethra are closed and very hypermobile, and the urethra descends more than 2 cm during stress that is, the angle of the urethra is increased. Type II patients also may have cystocele; if the cystocele is inside the vagina, the classification is Type IIA; if the cystocele is outside the vagina, the classification is Type IIB.

Type III, or intrinsic sphincter muscle deficiency, refers to severe stress incontinence in which urethral position and support are not factors, but the urethral sphincter is very weak. Type III patients often have undergone a previous, failed surgical procedure.

Risk Factors

Childbirth
In women, incontinence is often related to pregnancy and childbirth, which can weaken many of the pelvic floor muscles that provide the necessary support to the bladder neck and urethra, and are therefore important in continence. But, if a woman loses bladder control immediately after childbirth, she should not despair. The pelvic floor muscles may just need time to recover, and the incontinence may go away by itself.

If incontinence continues after 6 weeks, a physician should be contacted. Without proper treatment, urinary incontinence can become a chronic problem.

Incontinence also may be caused by other aspects of pregnancy and childbirth, such as a changed position of the bladder and urethra, episiotomy (a cut made in the pelvic floor/vagina, which makes it easier for the baby to come out), or damage to the bladder control nerves. Studies suggest that the more vaginal births a woman has had, the more likely she is to leak urine during physical activity.

Women who exercise the pelvic floor muscles usually have fewer bladder control problems than those who do not. Bladder control problems do not necessarily occur immediately after childbirth. Some women do not begin to experience incontinence problems until months or years after they have borne children.

Menopause
Between 45 and 55 years of age, most women's ovaries stop making estrogen: the female sex hormone that regulates monthly menstrual periods and controls how the body matures and adapts during pregnancy and breast-feeding. This reduction in estrogen causes menopause (the end of monthly menstrual periods). Lack of estrogen can result in a urethra with a thin lining that does not close properly. Lack of estrogen also weakens the bladder muscles. The combination of a thin atropic urethra, and weak bladder muscles can cause the urethra to open unexpectedly during physical activity, leading to stress incontinence.

Some of the signs of menopause-related bladder changes include:

• A strong, urgent need to pass urine
• A frequent need to pass urine

Painful urination
Fortunately, estrogen products are available for the treatment of incontinence caused by menopause. Women who have such incontinence have the option of choosing from a number of different forms of estrogen. However, every woman who thinks about using estrogen therapy should discuss the pros and cons with her physician. Estrogen products are available only by prescription.

Pelvic Surgery
Like pregnancy and childbirth, pelvic surgery can weaken and damage the pelvic floor muscles. As a result, the pelvic floor muscles may no longer be able to provide the necessary support to the bladder neck and urethra, and these structures may drop freely when downward pressure is applied. This condition, which is known as hypermobility, causes incontinence during physical activity, when the urethra cannot close tightly enough to resist increased abdominal pressure on the bladder.

Urinary incontinence can result from common forms of pelvic surgery, including abdominal resection for colorectal (intestinal) cancer, gynecologic (female genital tract) surgery such as total hysterectomy (complete removal of the uterus) or hysterectomy for benign (noncancerous) disease, and failed prolapse (restabilization) surgery for stress urinary incontinence.

Most patients with postoperative incontinence have either detrusor instability (DI or unstable bladder: an involuntary contraction of the bladder) or urethral/bladder neck incontinence (abnormal function) due to nerve damage. Successful management of DI incontinence usually can be achieved by drug therapy or use of pelvic floor exercises. Patients with bladder neck incontinence may require additional surgical measures.

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