Stress Incontinence Treatment Options and Management Techniques

If you've ever experienced an unexpected urine leak after laughing, sneezing, coughing, lifting or another form of physical exertion, you may be dealing with stress urinary incontinence. It can be quite upsetting when this happens, but it is important to know it’s very common.

This type of urinary incontinence often occurs due to weakened pelvic floor muscles and/or the tissues that support your bladder and urethra (the tube urine passes through), which normally help control urination.

While urine leakage can be unsettling, there's truly no need to feel embarrassed or afraid. This condition affects about one-third of women at some point in their lives. The good news is that there are many effective treatments available to ease your symptoms and improve your bladder health and overall quality of life.

In this article, we'll explore some of the different management techniques, lifestyle changes, medications, and procedures that are commonly used to treat stress incontinence.

Management Techniques for Stress Incontinence

Before looking into more involved options like surgical options or medications, your doctor will most likely recommend starting with a few of the following management techniques to see if they improve your quality of life and/or alleviate your symptoms:

Wear incontinence products

Most people with stress incontinence find specialised products like incontinence pants and incontinence pads helpful to manage leaks and prevent damage to their clothing while exploring other treatments. While these products don't address the underlying cause of your symptoms, they can give you the confidence to go about your day more comfortably.

Strengthen your pelvic floor

In most cases, a weak pelvic floor is a key factor in stress incontinence symptoms. The good news is that you can strengthen your pelvic floor muscles by performing pelvic floor exercises like kegel exercises: Contract and relax your pelvic floor muscles correctly and at timed intervals. A pelvic floor physiotherapist can ensure you’re doing these effectively.

Bladder training

Bladder training is a behavioural therapy that can help manage urgency, which sometimes accompanies stress incontinence, and trains your bladder to hold urine for longer. Bladder re-training is best done under the supervision of a healthcare professional. The first thing you will be guided to do is make a bathroom schedule and urinate at specific times each day. Gradually, you can aim to increase the amount of time between each bathroom break.

While bladder training is most often used to treat overactive bladder syndrome, it can also yield positive results for those with mixed incontinence ( a combination of stress incontinence and urge incontinence).

When you urinate, you can try double voiding, which involves urinating as normal and then waiting a moment before trying again, perhaps leaning forward slightly to ensure your bladder empties completely.

Manage your fluid intake

Drinking large amounts of liquid quickly can cause your bladder to become overly full, potentially leading to leaks. Conversely, drinking too little liquid can result in dehydration and concentrated urine, which can irritate the bladder. Most experts recommend drinking enough fluid throughout the day to keep your urine a pale straw colour - open around 1.5 to 2 litres, but the exact amount will depend on your age, location, climate and activity levels. It is often helpful to sip fluids steadily rather than drinking large amounts at once.

Treat underlying causes

Stress incontinence may sometimes be worsened by a treatable medical condition. For example, constipation can place added pressure on the bladder, increasing the risk of leaks.

By treating constipation through eating fibrous foods, ensuring adequate fluid intake, and participating in regular exercise, you can indirectly improve your stress incontinence. An appointment with your general practitioner can help determine whether or not your stress incontinence is being caused or worsened by any underlying conditions.

Medications for Stress Incontinence

While there isn't a specific medication that's been proven to "cure" stress urinary incontinence, the following options might be considered in certain situations:

Duloxetine

Duloxetine, an antidepressant, is sometimes prescribed off-label for stress incontinence in specific cases, particularly if other options haven’t been suitable or successful. While this medication can be effective for some, it can cause side effects and is not suitable for every patient, therefore it requires careful discussion with your doctor..

Vaginal oestrogen

For women experiencing menopause-related vaginal and urinary symptoms (genitourinary syndrome of menopause), which can include stress incontinence, low-dose vaginal estrogen creams, pessaries or rings may help. These treatments primarily aim to restore vaginal elasticity and moisture can improve the health of the tissues around the bladder and the urethra.

Though research on vaginal estrogen as a treatment specifically for stress incontinence alone is limited, it’s often a helpful part of management for those experiencing perimenopause and menopause.

Lifestyle Changes

Making certain lifestyle changes can improve your bladder health and help alleviate your stress incontinence symptoms. Here are a few changes you may want to consider making and your doctor might discuss:

• Maintain a healthy weight: Extra weight can put pressure on your bladder, making stress incontinence worse. Losing excess weight through a balanced diet and regular exercise can help reduce this pressure.

• Eat a nutritious diet: To support overall health, including bladder health, choose whole foods, vegetables, fruits and whole grains. Try to identify and limit personal bladder irritants such as caffeine, spicy food, artificial sweeteners, and fizzy drinks if they seem to worsen your symptoms.

• Quit smoking: Smoking can lead to chronic coughing which strains the pelvic floor, and also has a negative effect on connective tissue and bladder health more generally. Quitting offers many health benefits, potentially including improvement in stress incontinence.

• Limit your alcohol intake: Alcohol is a known bladder irritant and diuretic, so reducing intake may help manage symptoms.

• Make time for relaxing: Manage your stress levels by taking long baths, relaxing with your loved ones, and making time for the activities you enjoy is beneficial for overall well-being and may indirectly help manage incontinence symptoms.

Devices to Treat Stress Incontinence

When medications and lifestyle changes aren't providing enough relief, sometimes doctors will recommend urinary devices, such as pessaries and urethral inserts. Let's take a closer look:

Pessaries

A pessary is a small device, often made from rubber or medical-grade silicone that is placed in the vagina to provide support to the urethra and bladder neck. Different shapes and sizes are available, and they are fitted by a healthcare professional. The gentle compression it provides can help support the urethra.

Pessaries are a popular non-surgical treatment for stress incontinence but remember they need to be removed and cleaned regularly according to your doctor’s instructions to prevent complications like infections.

Urethral inserts

Urethral inserts are small single-use devices inserted by the patient into the urethra before activities known to cause leakage. These inserts act as a temporary barrier to prevent urine leakage when the patient participates in activities that trigger urinary incontinence. They can easily be inserted and removed by the user.

Surgical Options

Surgical treatment is typically only recommended for stress incontinence patients when other less invasive options haven't yielded satisfactory results nd the symptoms are significantly impacting quality of life. Some of the most common surgeries include:

Sling procedures

Sling procedures involve placing a sling made of either the patient’s own tissue or synthetic surgical mesh under the urethra to provide support. The sling acts as a support for the urethra, helping it stay closed during activities that increase abdominal pressure, thereby preventing urine leaks.

These procedures are usually considered minimally invasive and can yield impressive results with good long-term success rates. However, as with any surgery, potential complications are possible, and these should be discussed thoroughly with your surgeon.

Colposuspension

Colposuspension is an operation, often done abdominally (open or keyhole), that uses stitches placed strategically to lift and support the tissues near the bladder neck and urethra. It has historically shown good success rates, with most patients seeing a big improvement in their stress incontinence symptoms after the procedure. It is considered a more major operation compared to a sling procedure.

Urethral bulking agents

This treatment involves injecting special substances (bulking agents) into the urethral wall to add volume and help it stay closed and prevent urine leaks. The injections are usually done under local or general anaesthesia. Common bulking agents include Bulkamid (polyacrylamide hydrogel) and Durasphere (carbon-coated beads).

While urethral bulking agent injections often work well initially and are minimally invasive, patients might need repeated treatments for long-term results as the effect can wear off over time.

FAQs

What are the other types of urinary incontinence?

In addition to stress incontinence, the other main types of urinary incontinence include:

• Urge incontinence is characterised by a sudden and uncontrollable urge to pee, often leading to leakage before reaching the toilet..

• Mixed incontinence is a combination of both urge and stress incontinence symptoms.

• Overflow incontinence is the inability to completely empty your bladder, resulting in frequent dribbling or leaking.

• Functional incontinence is caused by physical or mental obstacles, such as limited mobility, severe arthritis, or neurological conditions, preventing timely bathroom access despite normal bladder function.

How is stress urinary incontinence diagnosed?

Your doctor can diagnose or investigate your stress incontinence by asking you about your symptoms, discussing your medical history, perhaps asking you to keep a bladder diary, doing a urine test (to rule out infection), and performing a physical examination. Sometimes, further tests like urodynamics may be suggested.

What is the most common cause of stress incontinence?

The most common causes and risk factors of stress incontinence include factors that weaken or damage the pelvic floor muscles and supporting tissues. These can include pregnancy, vaginal births, changes associated with menopause, chronic straining (e.g. from lack of exercise, obesity, chronic cough or chronic constipation), previous pelvic surgery and certain neurological conditions. Other risk factors include diabetes and pelvic organ prolapse.

How does stress incontinence impact day-to-day life?

Stress incontinence can impact your life by causing feelings of anxiety and embarrassment, especially when it comes to social settings and participating in physical activities. You may feel worried that you'll leak urine unexpectedly, so you may avoid making plans altogether. Additionally, stress incontinence may affect your sleep (if you also have urgency) and impact your sex life. It’s important to remember these impacts are valid and worth addressing.

Final Thoughts

Unexpected urine leaks can be frustrating, but stress incontinence doesn’t have to control your life. Though it affects about one-third of women, remember that there are a variety of effective treatments and management strategies available.

For years, Jude has been shedding light on women's bladder health issues, like stress urinary incontinence, through our online blog. We've also created a line of specialised urinary incontinence products to help support your bladder health. youe.

We always encourage you to seek advice from a healthcare professional, as with the right care and resources, you can successfully manage and even overcome stress incontinence. Take action today to reclaim your freedom and improve your quality of life!