Stress Urinary Incontinence - Stages, Symptoms and Treatment

Urinary Incontinence - Introduction

The frequent, involuntary leakage of urine from the bladder, which is therefore independent of our will, is a hygienic and social problem. Despite the significant severity of the symptoms, fewer than half of women report their symptoms to a doctor. Unfortunately, very often, those suffering from this condition are unwilling to actively participate in social and professional life and withdraw, which impacts their well-being and quality of life.

Urinary incontinence affects approximately 5 million Poles. Urinary incontinence affects approximately 25-45% of women, depending on age, and one in five men experiences difficulty urinating, including holding urine. The risk of urinary incontinence increases significantly in men after medical interventions.

Treatment of urinary incontinence includes eliminating the factors that aggravate the condition, lifestyle changes and implementing healthy daily habits, physiotherapy, and pharmacotherapy. If these methods prove ineffective, surgical treatment is recommended. This treatment should be followed by physiotherapy to maintain the surgical results.

Physiotherapy methods for urinary incontinence:

• pelvic floor muscle exercises (urethral diaphragm exercises),
• behavioral therapy (biofeedback, e.g., EMY, bladder training),
• pelvic floor electrical stimulation,
• mechanical aids (e.g., vaginal weights/Kegel weights).

Minitation rates in a healthy patient

Minitation is the medical term for the process of excreting urine from the bladder. It is a physiological process by which the body eliminates waste products and excess fluids. Micturition occurs through relaxation of the urethral sphincter muscles and contraction of the bladder muscle, allowing urine to flow from the bladder through the urethra and out of the body. This process is usually controlled by the nervous system, allowing for conscious stopping or initiation of urination.

• 300-600 ml of urine voided at one time
• Maximum 1 void at night (if drinking heavily at night)
• Urination every 3-4 hours
• Regular drinking during the day, totaling approximately 1-2 liters
• Difference between fluid intake and output: approximately 500 ml

Types of Urinary Incontinence

• Stress Urinary Incontinence
• Overactive Bladder
• Mixed Urinary Incontinence
• Other - Neurological

Stress Urinary Incontinence

This is the involuntary leakage of urine due to increased intra-abdominal pressure during physical activity or coughing. This may be caused by incompetent pelvic floor muscles, which can cause symptoms of incontinence, i.e., abnormal reactions from the pelvic floor. Very often, a lowered bladder neck causes a small amount of urine to leak during coughing or physical activity.

This article describes one type of urinary incontinence. 

Symptoms of Stress Urinary Incontinence

Stress urinary incontinence is characterized by uncontrolled urine leakage. In stress urinary incontinence, the urine stream is usually not forceful or continuous, as is the case with normal voiding. Instead, the leakage is usually uncontrolled and consists of small amounts that are released due to increased intra-abdominal pressure. Below are the most common symptoms of this type of incontinence:

• Urine leakage due to a sudden increase in intra-abdominal pressure, e.g., during sneezing or coughing
• Urine leakage while performing household chores, e.g., cleaning, climbing stairs, jumping, running, or during physical activity
• Urine loss without prior urge to urinate
• Urine leakage (small amounts)
• The person manages to reach the toilet after feeling the urge to urinate
• Frequent urination in small amounts
• Urinary incontinence

Causes of Stress Urinary Incontinence

The main cause of stress urinary incontinence is weakened pelvic floor muscles. Many processes can contribute to their weakening, which we will try to list below:

• pelvic floor muscle failure and weakness
• congenital connective tissue insufficiency
• reduced or increased pelvic floor muscle tone
• prolapse of internal organs
• previous childbirth
• overweight (obesity)
• low estrogen levels
• age-related involution
• stimulants
• comorbidities
• surgeries, pelvic injuries
• intensive exertion
• chronic cough
• hypertension medications, relaxants
• poor daily habits
• lifestyle

Three degrees of severity of stress urinary incontinence:

Grade I
Urine leakage with intense and sudden physical exertion – severe coughing, sneezing. Pelvic floor therapy involves pelvic floor muscle exercises to completely eliminate urinary incontinence.

Grade II
Urine leakage with moderate physical exertion – climbing stairs, cleaning, jumping, running, gardening. Pelvic floor therapy involves pelvic floor muscle exercises to slow down further processes that deteriorate tissue function and improve their function.

Grade III
Urine leakage during leisurely walking, at rest, or while lying down. Surgery is recommended for this degree of severity, but it's important to remember that pelvic floor muscle exercises are necessary afterward, as otherwise the problem will return – conservative treatment.

Pelvic floor muscle functions

• Supporting internal organs to prevent them from moving downward
• Reflex response during sneezing and coughing, for example
• Relaxation and opening during urination and defecation
• Sexual function, relaxation during intercourse

Treatment of stress urinary incontinence - what to do?

• Pelvic floor muscle training
• Proper habits during daily activities
• Proper toileting habits
• Keeping a voiding diary
• When coughing or sneezing, remain straight, legs crossed, and do not bend your legs
• Reducing the urge to urinate and defecate (preferably eliminate it completely)
• After urinating or defecating, tighten your pelvic floor muscles as if you were trying to pull them up along with your underwear
• Be aware of the stresses acting on the pelvic floor during daily activities (exhalation = exertion)
• Reducing the wearing of clothes that constrict the abdomen

Other treatment methods used in UI therapy:

• Vaginal cones - educator
• Weighted vaginal cone
• EMG - biofeedback
• Pelvic floor exercises using pressure biofeedback, e.g., Emy
• Supporting tampons, e.g., Contrelle bladder stabilizer
• Geisha balls

Is Kegel exercise necessary?

The pelvic floor muscles are also called Kegel muscles; they are the same muscle structures. Urinary incontinence, in the context of urine loss during daily activities, is primarily due to weakened muscle structures in the pelvic floor. Year after year, unexercised pelvic floor muscles lose their strength, and the problem can worsen. To prevent this, daily pelvic floor exercises should be performed to improve their trophic strength.

Pelvic floor muscle strengthening exercises (PFM) - benefits for the patient

• No worsening of the problem - no need to use more pads year after year
• Improved muscle endurance and the number of pads used will decrease
• Reduction in the number of intimate bladder or vaginal infections
• Improved quality of life in terms of hygiene and social well-being

Proper habits

• Correct position on the toilet - no "small-ass" position
• Do not "pee" in advance
• Do not urinate while urinating or defecating
• Do not hold urine (with an overfull bladder of approximately 500/600ml)
• Tighten the pelvic floor after voiding or defecating
• Proper sneezing and coughing
• Proper body posture - straighten up
• Proper lifting of weights - from your knees
• Proper getting up from bed/couch - from the side
• Healthy habits for urinary incontinence