Many middle-aged and elderly female friends often have this experience, a sneeze, a laugh, a small jog to catch the bus …… urine surprisingly involuntary leakage, it is really embarrassing. If this happens often, you can be alert, stress urinary incontinence begins to interfere with your normal life.
What is stress urinary incontinence?
Stress urinary incontinence (SUI) is the involuntary escape of urine from the urethra due to increased abdominal pressure (e.g., strenuous exercise, laughing, sneezing, coughing) and is commonly seen in women and is associated with relaxation of the bladder support tissues and pelvic floor muscles in women.
Research studies have found that 23%-45% of the female population suffers from varying degrees of urinary incontinence, of which about 50% is stress incontinence, with a particularly high prevalence in postmenopausal women. Due to frequent urine loss and leakage, the patient’s perineum is often wet, and the heavier ones can not leave the pad at all times, incontinence can have different degrees of impact on women’s work, social life, sports, travel, sex life, etc., so incontinence is also known as “social cancer. It causes a great deal of physical and psychological shadows for the patient, and even leads to depression, which has become an unspeakable problem for many women.
Why does stress urinary incontinence occur?
1. Age
With the age of the pelvic floor relaxation and degenerative changes in the urethral sphincter, the prevalence of female incontinence gradually increased, the high incidence of age 45 to 55 years.
2, childbirth
Women who give birth vaginally are more likely to have urinary incontinence than women who give birth by cesarean section, and those who give birth too old, have huge children, and have a history of difficult births will increase the likelihood of stress incontinence.
3.Lower estrogen levels
Mainly after menopause, with the ovarian function declining, estrogen levels drop sharply, resulting in pelvic support structure relaxation, bladder prolapse; due to the reduction of estrogen, the submucosal vascular network of the urethra atrophies, so that the urethral smooth muscle relaxation, closure force decreases, the urethral muscle group urinary control ability decreases.
4.Other
Obesity, history of pelvic surgery, constipation, racial and genetic factors are all related to the occurrence of stress urinary incontinence.
How is stress urinary incontinence diagnosed?
A clear diagnosis is made based on the typical symptoms of stress urinary incontinence, i.e. whether urine overflows when various levels of abdominal pressure increase, such as laughing, coughing, sneezing or walking, and whether the flow of urine stops immediately when the pressure action is stopped. A professional diagnosis also includes the necessary physical, laboratory and instrumental examinations, pressure-induced tests, urine pad tests and incontinence questionnaires. Care should also be taken to differentiate from common incontinence such as urge incontinence and overflow incontinence.
Stress incontinence is divided into three degrees: mild: no incontinence during general activities and at night, occasional incontinence when abdominal pressure increases, no need to wear a pad. Moderate: frequent urinary incontinence with increased abdominal pressure and rising activities, requiring the wearing of pads. Severe: Urinary incontinence occurs when rising and moving or when the position of the patient changes, which seriously affects the patient’s life and social activities.
How to treat stress urinary incontinence?
1.Good lifestyle
Weight loss, smoking cessation, change of diet, etc.
2.Pelvic floor muscle training
Through active pelvic floor training (Kegal exercise) or passive pelvic floor training (biofeedback electrical stimulation physiotherapy) will be strong pelvic floor muscle groups, so that the urethral sphincter will be strong, increasing the urethral closure pressure and reducing urinary incontinence. This method is convenient and easy to use and is suitable for mild stress incontinence. Incontinence symptoms may recur after stopping training.
3.Drug treatment
Mainly selective α1-adrenergic receptor agonists, which can stimulate the α1 receptors of urethral smooth muscle and increase urethral resistance. Side effects are hypertension, palpitations, headache, chills in the extremities, and in severe cases, stroke can occur. All drug treatments are only suitable for mild urinary incontinence.
4.Surgical treatment
It is suitable for patients who have poor results or cannot adhere to conservative treatment, cannot tolerate it, have poor expected results, and patients with moderate to severe stress urinary incontinence, which seriously affects the quality of life, etc. The principle is to cure urinary incontinence by placing a sling at the level of the mid-urethra through a minimally invasive route to provide good closing pressure. The procedure has the advantages of minimal injury, good efficacy (over 95% success rate), and short hospital stay, and the main modalities are TVT, TOT, and Needleless.