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Stress Incontinence: Diagnosis And Treatment

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Stress incontinence is diagnosed by a combination of history, physical examination and some investigations like USG. When one visits a doctor, one can expect the doctor to take a detailed history. Therefore patients must go prepared to answer questions about their problem in detail.

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Stress incontinence is diagnosed by a combination of history, physical examination and some investigations like USG. When one visits a doctor, one can expect the doctor to take a detailed history. Therefore patients must go prepared to answer questions about their problem in detail. It is worthwhile to keep a pad and pen as one visits the doctor. Important symptoms can be penned down and important questions can also be noted down. This will help the doctor evaluate the problem in a much clearer way.

Once this is done a complete examination will be done by the doctor with particular emphasis of the abdomen and pelvis. During this time, pelvic examination may be necessary to evaluate the general condition of pelvic structures. The doctor will also do a neurological exam to check for any neurological problems which could be causing incontinence.

You will then require to undergo a few basic blood tests to look for common co-existing diseases and a urine examination to look for protein, infection and traces of blood.

You will also need to undergo some specialised tests will measure bladder function. Measurement of post voiding urine volume is one such test. In this test the amount of urine in the bladder pre and post voiding is measure by means of ultrasound. Other tests include cystometry and video uro-dynamics.

How is this condition treated?

Initially this condition is managed by education and life style measures. Patients should limit their fluid intake to the amount recommended by doctor. One must avoid alcohol and caffeinated drinks. It is also preferable to schedule regular pit breaks to go to the bathroom, this way there will be less urine in the bladder to dribble.

It is also important to lose any extra weight and quit smoking. Weight loss is a very good way to manage stress incontinence. Pelvic floor exercises should be an important part of the treatment.

If these are not effective then one can use some devices like urogenital diaphragms which fit like tampons and are used during specific tasks. But these devices suffer from many disadvantages.

Is Surgery Needed?

Surgery is very effective in treatment of stress incontinence. In fact it is the only effective treatment if life style measure fails. Surgery generally aims to buttress the support of the bladder and strengthen the sphincters. During this procedure, redundant lax tissues are excised and the remaining tissues approximated to provide support to the bladder. Similarly the urethra is pulled up by using a sling and this help to kink the urethra while the bladder is relaxed thus preventing involuntary leak of urine. Alternatively bulking agents like collagen can be injected into the surrounding tissues to provide strength and support.

Presently inflatable balloon sphincters are also available which can be used to supplement a poor functioning sphincter.

How does weight affect this condition?

As mentioned above weight plays a very important role in stress incontinence. Obesity increased the intra abdominal pressure at rest. Hence the pressure required to trigger a urine leak is much less in obese subjects, therefore weight loss is very beneficial in stress incontinence.



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