9 June 2021 Author : Manuela Costa Stress urinary incontinence is the involuntary loss of urine in situations or activities where there is an increase in intra-abdominal pressure , as is the case, for example, with: To laugh; Cough or sneeze; Running, jumping and other forms of activity and physical exercise; Load weights. Stress urinary incontinence is a common problem, affecting 10%-20% of women. Many consider that it is a “normal” problem, despite affecting their life in several ways, like social, relationship, physical activity limitation; They are unaware of the existence of simple and effective treatments. Causes of stress urinary incontinence The urethra and bladder are supported by the pelvic floor muscles. Under normal circumstances, when intra-abdominal pressure increases, the contraction of the pelvic floor muscles strengthens the support for the bladder and urethra and prevents the flow of urine. The dysfunction of the pelvic floor muscles and sagging support tissues are the causes of involuntary urinary losses in stress urinary incontinence and are mainly due to : Pregnancy and vaginal delivery; Obesity; Chronic cough; Repeated efforts; Constipation; Genetic causes associated with greater tissue flaccidity. Changes in the urethral sphincter can also be a cause of stress incontinence. Diagnosis In view of complaints of involuntary urine leakage, it is necessary to resort to medical care to have a correct diagnosis and thus the best treatment option is choose. The diagnosis is made in gynecology or urology consultation, and considers: History of urine leakage and circumstances in which it occurs It is very important to report everything in detail, without omissions; In many women there is both stress urinary incontinence and urgent urinary incontinence and sometimes gas or stool incontinence. Clinical observation to assess these losses and check for associated prolapses In this observation, women may be asked to cough with a full bladder, but still comfortable. To determine the most appropriate treatment , it may still be necessary to perform: A urine diary, that is, a record of the hour when urine, the urine volume and involuntary leakage of urine, either during the day or during the night; Bladder ultrasound, to assess the structure of the bladder and determine the amount of urine that remains in the bladder after urinating (residual volume); Urodynamic study, which assesses the physiology of urination, that is, how the bladder, urethral sphincter and urethra retain and release urine; Urine culture, to rule out the possibility of an infection. Treatment The therapeutic options available for stress urinary incontinence can be grouped into two types; Conservative treatment; Surgical treatment. Conservative treatment of stress urinary incontinence This group includes: Lifestyle changes , for example stop smoking, diet changes and physical exercise to lose weight and avoid constipation; Pelvic floor physiotherapy . If it is a mild incontinence, there can be significant improvement in symptoms, especially when the exercises continue to be done regularly and for prolonged periods, at least 3-6 months. Stress urinary incontinence surgery Surgical treatment aims to obtain better support of the urethra and/or a more effective closure of the urethral sphincter . Depending on the cause of incontinence - hypermobility of the urethra or incompetence of the sphincter - there are two possible interventions: Placement of a suburethral mesh or prosthesis (TVT) that provides support to the urethra, preventing excessive mobility and, consequently, urine losses with efforts; Injection of collagen in the area of the urethral sphincter, allowing its complete closure. Meet the obstetrics-gynecology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
