Treatment. Stress incontinence

Diagnostics of stress incontinence

Your appointment with a doctor will include familiarizing the doctor with your medical history, physical exam, urine testing, quick neurological exam and urinary stress test. By assessing all of the results, your doctor will be able to identify the root of the problem.

Test of bladder function

The common types of urinary incontinence usually do not require further testing. Though, in some cases, your doctor may ask you to undergo a urodynamic test to assess the functioning of your bladder, urethra, and sphincter.
Bladder function test includes:

• Cystometry. Cystometry measures the pressure in the bladder and surrounding areas while the bladder is filling. The doctor will ask you to bear down or cough while filling your bladder with warm fluid by the catheter. The goal of this procedure is to test your bladder for leaks. The doctor may combine cystometry and a pressure-flow study in order to determine how much pressure your bladder needs to exert to empty fully.
• Cystoscopy. To perform this test, your doctor inserts a scope into your bladder to see if there are any abnormalities or blockages in the bladder and urethra.
• Making images of the bladder while it functions. Video urodynamic uses images to construct pictures of your bladder being filled and emptied. The specialist records the image while filling your bladder with the warm fluid with an X-ray-visible dye by catheter. Also, as the bladder empties, imaging continues.
• Measurements of post-void residual urine. This test shows the ability of your bladder to empty completely. Using an ultrasound scan, your doctor can estimate the amount of urine left in your bladder after urination. Furthermore, sometimes, a specialist passes a thin tube, a catheter, through the urethra to rich your bladder. The remaining urine is drained with a catheter and measured.

Behavioral treatment of the stress incontinence

Behavioral therapy may help you to reduce the number of episodes of stress urinary incontinence. Such methods include:

• Kegel exercises. Kegel exercises may strengthen your pelvic muscles and urinary sphincter. Your physician can help you to learn how to do Kegel exercises. In addition, biofeedback may be beneficial. By using pressure sensors, biofeedback helps you understand if you’re contracting your muscles with the right intensity and length of time.
• Healthy lifestyle. Chronic cough treatment, smoking cessation and loss of excess weight may ease your symptoms and reduce the risk of stress incontinence. 
• Consumption of fluid. You may discuss with your doctor how much liquids you should consume during the day. Though, you don’t need to limit your fluid consumption so much that you end up dehydrated. Also, it is beneficial to exclude the consumption of caffeinated, alcoholic and carbonated beverages.
• Bladder training. Scheduling your voiding may be beneficial if you have mixed incontinence. In addition, by urinating more frequently, you may be able to reduce the number of urge incontinence episodes.

Medications for stress incontinence treatment

The US does not approve any drugs for the treatment of stress incontinence. However, doctors in Europe may recommend using antidepressant duloxetine to relieve stress incontinence symptoms. Unfortunately, the drug has the side effect of nausea, and the symptoms return after ceasing use.

Devices for stress incontinence control

• Urethral inserts. It is a small disposable tampon-like device that you can insert into the urethra to prevent leakage. Although urethral inserts are usually used to avoid urine leakage throughout specific activities, you can wear them during the day. However, you can wear urethral inserts for up to 8 hours per day.
• Vaginal pessary. Incontinence vaginal pessaries are devices that are shaped like a ring and have two bumps on each side of the urethra. The main goal of pessary installation is to support your bladder base. As a result, it prevents urine leakage during activity. It is important to remove and clean pessary routinely.

Stress incontinence surgery

In the case of stress incontinence, surgical strategies include supporting the bladder neck or improving the bladder sphincter. Such methods include:

• Injectable bulking agents. The doctor may prescribe synthetic polysaccharides and gels to increase the area around the urethra and subsequently enhancing the function of the sphincter. These materials are injected into tissues around the upper portion of the urethra.
• Sling procedure. To perform this procedure, the surgeon makes a special sling or hammock supporting the urethra. The surgeon has several options to create them: using patient’s tissue, donor or animal tissue, or synthetic mesh. In addition, slings are applied for the treatment of men with mild stress incontinence.
• Retropubic colposuspension. This procedure aims to support and lift tissues near the upper part of the urethra and near the bladder neck by stitching sutures to ligaments along the pubic bone. Also, a surgeon can perform the procedure via an abdominal incision or through laparoscopic means.
• Inflatable artificial sphincter. This procedure treats stress incontinence in men by placing a cuff around the upper part of the urethra. The cuff substitutes the sphincter function. Meanwhile, several tubes connect the cuff to a pressure-regulating balloon located in the pelvis and a manually operated pump in the scrotum.

Home remedies and lifestyle

Quitting smoking, adding fibre-rich food to your diet, losing extra weight, escaping food and beverages that may irritate the bladder, and other lifestyle-changing methods may ease the stress urinary incontinence symptoms.