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Stress urinary incontinence (SUI) is defined as involuntary passage of urine on coughing, sneezing or laughing. The incidence of stress urinary incontinence amongst women is observed to be 11%, but the actual statistics suggest the significance of over 50% to 60%. The 11% population which is evident forms just a minor group of women who visit their doctor with the complaint. And this is just the tip of the iceberg.
Most women are unaware of definite treatments available and presume that they have to live with the problem. According to a study published in Muller Journal of Medical Science and Research, the prevalence of urinary incontinence due to stress is 54.61% in India.
Stress urinary incontinence in women is caused by physical changes in the pelvic floor—which is influenced by vaginal childbirth, instrumental deliveries, obesity, menopause or in rare cases, Ehlers-Danlos Syndrome (EDS).
Typically, after childbirth women start to complain of bladder weakness and involuntary passage of urine on coughing, sneezing, laughing, jumping or gymming.
Normally, the urinary bladder and the urethra functions in such a way that urethral pressure always exceeds the bladder pressure and hence, the patient does not leak urine.
Due to childbirth, the urethral pressure is reduced due to damage to the pelvic muscles.
In menopause, due to lack of collagen and elastin, the urethral integrity is compromised. Then, on increasing the abdominal pressure with actions such as coughing, sneezing or laughing, the patient is unable to hold urine as now the bladder pressure exceeds the urethral pressure due to the reduced urethral integrity.
Certain medical conditions like diabetes can further complicate the issue, and the patient can manifest with urge and stress incontinence. Ruling out cystitis in diabetes and keeping a check on blood pressure is absolutely imperative. Most commonly, the sudden urge to pass urine is treated by bringing blood sugar in control, treating infections, offering female probiotics, and local oestrogen creams.
All patients—whether suffering from stress or urge incontinence—have to undergo a thorough gynaecological examination which includes a physical examination to check for local hygiene or infection (atrophic vaginitis), a Pap smear, a bimanual examination, abdominal and trans-vaginal ultrasounds.
Ultrasound can also rule out chronic cystitis and problems with emptying the bladder.
Having ruled out diabetes and infections, the Kegel exercise is a conservative approach to enhance the integrity of the pelvic floor muscles which in turn could assist in enhancing the urethral pressure and hence reduce the severity of incontinence.
Typically, a patient is asked to contract the pelvic muscles hard for a period 30 seconds in 3 sessions during a day for a period of 3 months. The efficacy of Kegel exercises can be enhanced with local application of oestrogen creams in peri-menopausal women.
In women, who do not benefit from conservative methods, techniques to enhance urethral pressure have been introduced.
All in all, stress urinary incontinence can greatly affect your life. So if you are battling the issue, don’t shy away from paying your gynaecologist a visit.