Stress Urinary Incontinence

To many people, Stress Urinary Incontinence (SUI) might sound like something unusual or rather uncommon. On the contrary, this is one of the most common urinary incontinence in the world today. It is a condition described by the involuntary leaking of urine from the bladder or urethra. This usually occurs when sudden pressure is exerted on the body, maybe due to exercise, sneezing, laughing or coughing. This condition is more common among women than men. It can be a nuisance to its patient and affect their lives negatively. There are many ways to help treat or manage this condition. Avané clinic, Nairobi, is proud to be one of the few institutions that offer Stress Urinary Incontinence (SUI) treatment in Kenya.

What is Stress Urinary Incontinence?

This is a form of urinary incontinence that allows urine to leak out of your body. This can happen during exercise, laughing, coughing or even sneezing. Physical exertion like jumping, running or lifting heavy objects might also cause the leak. The leakage occurs due to the exertion of pressure on the bladder or urethra, causing the sphincter muscles to open briefly. SUI can be mild or severe, depending on the nature of the leakage. In mild SUI, the leakage is caused by forceful activities such as coughing, sneezing or jumping. The leakage is usually minor, just about a few drops. On the other hand, in severe SUI, the leakage may happen with less forceful activities like standing, walking or bending. The urine leakage can range from just a few drops to enough urine to soak through the clothes.

Are there any other forms of urinary incontinence?

Stress Urinary Incontinence is the most common form of bladder problem. The other form of common bladder problem is called the Overactive Bladder (OAB). This is a condition where the patients feel a sudden urge to empty their bladder, and they cannot control it. Oftentimes, people with OAB may have some urine leaks. The difference between SUI and OAB is anatomical. SUI is a urethral problem while OAB is a bladder problem. With SUI, the urethra cannot stop the sudden increase in pressure. On the other hand, with OAB, the bladder spasms and squeezes uncontrollably. In instances when both occur at the same time, this is called Mixed incontinence.

How common is Stress incontinence?

As earlier mentioned, SUI is more prevalent among women than in men. About 1 in 3 women suffer from SUI at some point in their lives. Urinary incontinence increases with age, due to the continued weakening of the body's muscles. Additionally, about a third of women aged 60 years and above find that they sometimes leak urine. Over half of women with SUI also have OAB. Men are less affected by this condition. However, there are more cases of OAB among men than those among SUI. In Men, SUI might have most likely resulted due to a prostate cancer surgery or pelvic nerve injury.

What are the risk factors for stress incontinence?

Being female means one is at a higher risk than their male counterpart. Additionally, aged people are also at greater risk of having stress urinary incontinence. Women over the age of 60 have reportedly noticed urine leakage. It is important to note that SUI isn’t a normal part of ageing. Rather, it is a sign of a defect that can get better when well-treated. Other risk factors associated with increased chances of getting Sui are:

•        Pregnancy and childbirth (vaginal birth)
•       Menopause
•        Nerve injuries in the pelvic region
•       Obesity
•       Chronic coughing
•       Prostate cancer surgery or enlargement of prostate glands
•       Diabetes
•       Pelvic surgery
•       Uterine prolapse

Diagnosis of stress Urinary Incontinence?

Before any treatment, you should visit our doctors at Avané clinic for a consultation. During the consultation, that doctor enquires about your medical history, among other personal details. These details help them determine the possible causes, extent and type of the defect. The doctor also performs a physical examination, which might include a rectal examination and a pelvic examination in women. In addition to this, the doctor will request a urine sample to test for infection, traces of blood or other abnormalities. A brief neurological examination will also be done to identify if there is any pelvic nerve damage. In addition to this, a urinary stress test is also conducted. Here, the specialist observes urine loss when you cough or bear down.

What are other tests that might be needed?

Common causes of urinary incontinence usually don't require additional tests. However, in some cases, your doctor might order tests to assess how well your bladder, urethra and sphincter are functioning (urodynamic tests).

Bladder function tests may include:

• Urinary pad test: This involves you wearing an absorbent pad(s) for 24 hours at home. The doctor weighs the pad after use to determine the volume of leaked urine.
• Urinalysis: This test checks for signs of infection in a urine sample. Urinalysis can help determine if you have a urinary tract infection (UTI) or blood in your urine (hematuria). These signs may indicate a different problem.
• Bladder scan: A brief ultrasound in your doctor’s office to make sure you are emptying your bladder when you pee.
• Ultrasound: A pelvic or abdominal ultrasound assesses the health of the bladder, kidneys and other organs.
• Cystoscopy: During a cystoscopy, your doctor uses a scope to examine your urinary tract.
• Urodynamic testing: This group of tests gauges how well your urinary system holds and releases urine. Urodynamic testing includes a postvoid residual urine test. The test measures how much urine is still in the bladder after you pee.

Possible treatments for SUI.

There are several forms of treatment for this condition. The type used usually depends on whether you are having mild SUI or severe SUI. After the tests, the doctor comes up with a diagnosis and discusses the results with you. Moreover, he also discusses the available treatment with you and guides you in selecting the best treatment. Treatment offered can be in form of behavioural therapies, medication or the use of devices. In some cases, the doctor may recommend surgical intervention, should the need be dire.

Behavioural therapies.

This help to eliminate or lessen the occurrence of episodes of stress incontinence. They include:

• Kegel exercises- These are exercises meant to strengthen the pelvic floor muscles and the urinary sphincter. You must work on them correctly and regularly. The success of the exercise is highly dependent on the correctness and frequency of the exercises. In addition, Kegel exercises can be complemented using the biofeedback technique. Biofeedback involves the use of pressure sensors or electrical stimulation to reinforce the proper muscle contractions.
• Fluid consumption- This involves regulation of how much fluids you consume. The doctor advises you on how much fluids to take during the day and during the night. In addition, the doctor may also recommend avoiding carbonated, caffeine or alcoholic beverages. This is because such drinks can irritate the bladder, and increase its activeness.
• Healthy lifestyle changes- Quitting smoking, losing excess weight or treating a chronic cough lessens your risk of stress incontinence and improves your symptoms.
• Bladder training- Your doctor might recommend a schedule for toileting if you have mixed incontinence. More frequent voiding of the bladder may reduce the number or severity of urge incontinence episodes.

Use of devices.

There are several devices that are used to help women control stress incontinence. These include:

• Vaginal pessary- This is a specialized urinary incontinence pessary, shaped like a ring with two bumps that sit on each side of the urethra. The device is fitted and put into place by your doctor. It helps support your bladder base to prevent urine leakage during activity, especially if your bladder has dropped (prolapsed). A pessary will require routine removal and cleaning. Pessaries are used mostly in people who also have pelvic organ prolapse.
• Urethral insert- This is a small tampon-like disposable device inserted into the urethra. It acts as a barrier to prevent leakage. It's usually used to prevent incontinence during a specific activity, but it may be worn throughout the day. Urethral inserts can be worn for up to eight hours a day. They are generally used only for heavy activity, such as repeated lifting, running or playing tennis.

Surgery.

Surgical procedures are usually used as a last result, where no other intervention was helpful. They are designed to offer closure of the sphincter or to support the bladder neck. Surgical procedures include:

• Injectable bulking agents. Synthetic polysaccharides or gels may be injected into tissues around the upper portion of the urethra. These materials bulk up the area around the urethra, improving the closing ability of the sphincter.
• Sling procedure- It is the most common procedure performed in women with stress urinary incontinence. The surgeon uses your tissue, synthetic material (mesh), and animal or donor tissue to create a sling or hammock that supports the urethra. Slings are also used for men with mild stress incontinence. The technique may ease symptoms of stress incontinence in some men.
• Inflatable artificial sphincter. This surgically implanted device is used to treat men. A cuff, which fits around the upper portion of the urethra, replaces the function of the sphincter. Tubes connect the cuff to a pressure-regulating balloon in the pelvic region and a manually operated pump in the scrotum.

Takeaway.

Stress Urinary Incontinence is a common condition, that may affect anyone. It can make you feel ashamed of yourself and might make you feel less loved. It may also make you feel less desirable and less beautiful. The good news is that the condition is treatable. At Avané clinic, we have brought this treatment close to you, and at affordable and friendly costs. We are located at the Yaya centre, in Nairobi, Kenya. Visit us here for a consultation, testing and treatment. You could also feel free to contact us to book an appointment or make enquiries about this treatment.