Stress Urinary Incontinence (SUI)
Involuntary leakage of urine associated with activites that increase
- ♂ Males - SUI is rare in men; most cases occur post prostatectomy. About 5-20% of men will experience SUI as a complication from prostate cancer treatment. Strengthening pelvic muscles prior to surgery has been shown to reduce post-op incontinence. *
- ♀Females - "One of every three women will experience Stress Urinary Incontinence (SUI) at some point during their lives." *
- Etiology may be childbirth, low estrogen,
obesity, recent urinary catheterization, or surgery.
- Urethral hypermobility due to anatomical
changes such as weakened pelvic floor muscles, or defects
such as fascial detachments.
- Intrinsic urethral deficiency (ISD)
is due to a weakening of the muscle of the urethra.
SIGNS & SYMPTOMS:
Mild SUI - A small amount of urine lost during rigorous physical
activities including: sports or exercising, sneezing, laughing, coughing, or lifting.
Moderate to severe SUI - larger volumes of urine loss or incontinence that occur with low impact movements such as standing up, walking, or bending over.
- ♂♀ Urinate more often to reduce the amount of urine that leaks
- ♂♀ Avoid constipation and straining at stool
- ♂♀ Avoid bladder irritants: caffeine, tobacco, alcohol, spicy food, citrus, carbonated drinks
- ♂♀ Pelvic
- ♂♀ Biofeedback
- ♀ Vaginal weight training with cones
- ♂♀ Pelvic floor electrical
- ♂♀ Bladder training, usually
- ♀ Estrogen cream
remains controversial regarding its efficacy.
- ♀ Pessaries are available in many forms and sizes. Properly fit, they are a safe and effective option but must be fit by trial and error.
- ♂♀ Duloxetine - works like an SSRI but also blocks re-uptake of Noradrenaline. Off label use in patients who do not want or are unsuitable for surgery and ♂ post prostate surgery.
- ♂♀ Intramural Bulking Injection - Collagen, silicone or another material is injectied into urethral wall just distal to the bladder neck. Bulking injection is not as successful as sling procedures; repeat injections may be required over time.
- ♀ Burch Colposuspension restores the urethra and vagina to functional positions by elevating the bladder neck and stitching the periurethral tissue to the to Cooper's ligaments.
- ♀ Marshall-Marchetti-Krantz urethropexy elevates the urethra and bladder neck by stitching the periurethral tissue to the pubic periosteum.
- ♂♀ Sling Procedures - Trans Obturator (TOT), Suburethral (SUT) and Tension free Vaginal (TVT). Slings can be inserted to support a prolapsed urethra and return the external urethral sphincter to full function. The slings are either the autologous fascia grafts or synthetic fibres. Risk of post-operative obstruction can be significant.
- ♂♀ Artificial Urinary Sphincter Insertion - may be considered if previous surgery has failed.
Stress incontinence can respond
to exercises that strengthen the muscles in the pelvic floor.