Symptoms of stress urinary incontinence SUI
- accidentally leaking urine when you exercise, laugh, cough or sneeze
- needing to get to the toilet in a hurry or not making it there in time
- constantly needing to go to the toilet
- accidentally losing control of your bladder or bowel
- accidentally passing wind
These symptoms are the result of the muscles around the bladder neck or sphincter not being able to contract enough to withstand the pressures from the pelvic and abdominal cavity above.
Women’s health physiotherapists describe this as the ‘intra- abdominal pressure’ IAP exceeding the ‘intra vaginal pressure’ and therefore causing ‘stress’ leaks.
Some women only experience this with a full bladder and think that it’s OK …it’s still stress urinary incontinence…and we must NOT be soothed by our various incontinence product manufacturers to believe that ‘light bladder leakage’ is the norm.
If you are not confident that you can identify and contract the pelvic floor muscles
- contact Sports Focus Physio today and have a Pelvic (internal vaginal) assessment
- see your GP if you are concerned to exclude other pathology
- reduce your ‘stresses’ on your pelvic floor
- reduce lifting small and large children
- address excess weight with a ‘safe’ exercise programme
- reduce any coughing or sneezing due to viruses, chronic chest problems or allergies by reviewing your medications
- if you are doing high impact exercises- running, bootcamp / boy exercises and ignoring the problem STOP now you are only making the problem worse
- if you work with a personal trainer, tell them your problem- you would do so if you had a sore knee or back injury. If they can’t modify your programme …come and see me. I love putting my personal trainer hat on and guiding you into safe exercise options
Sometimes pelvic floor exercises are not enough and don’t fix the problem. We, as women’s health physios need to be able to admit this and refer on to GP – Urogynae – Gynae – Colo rectal specialists for further advice / investigation and possible surgery.
So what are the surgical options for SUI
Surgery is only recommended after the exact cause of urinary incontinence has been found. Strengthening exercises are still the 1st treatment approach generally for SUI
Colposuspension – this procedure involves the bladder neck being lifted back to its proper position. The front wall of the vagina (where the urethra is located) is lifted and stitched to strong ligaments near the pubic bone. The most popular type of colposuspension procedure is Burch colposuspension, which can be performed both abdominally and laparoscopically (key-hole surgery).
Sling procedure – in this procedure, a piece of fascia (strong tissue that covers the body’s muscles) or a synthetic material such as mesh tape, is placed under the urethra like a hammock to support it. Some sling procedures are performed while you are under a general anaesthetic, while others can be done using a regional anaesthetic. The procedure generally requires small incisions in the abdomen and/or vagina.
Surgery should only be considered after you have trialled conservative treatments and undergone a urodynamic assessment to ensure the diagnosis is correct and your condition is favourable to surgical correction. Success rates and risks vary for different procedures and so you should discuss this with your doctor prior to surgery. Surgery may not result in a complete resolution of incontinence symptoms. Surgery is generally not performed unless a woman is not planning any further pregnancies, as pregnancy will impact the ongoing results.
Intrinsic Sphincter Deficiency ISD
ISD another type of SUI where the urethra (tube from your bladder) lacks the normal closing pressure needed to prevent leakage on activities. In ISD, the bladder outlet is open at rest and urine can leak through even with lighter impact activities. It’s like a garden hose that you stand on…but not quite enough to stop the flow.
The neck of the bladder is not staying closed ‘tightly’ The most severe form of ISD-related stress urinary incontinence is that of the fixed ‘lead-pipe’ urethra.
Closure is achieved by a combination of factors including the strength of the connective tissue, (intact pelvic fascia and ligaments) the blood flow to the urethra, the health of the lining of the urethra and the strength of the muscle surrounding the urethra.
Several problems may compromise this closure:
- Tearing of the nerves to the sphincter during childbirth
- Peripheral neuropathies as occur with diabetes and other causes.
- Increased age.
- The lack of Oestrogen in that area in the post-menopausal phase of a woman’s life.
- Trauma from surgery [e.g. vaginal repair, urethrotomy].
Intrinsic Sphincter Deficiency [ISD] is diagnosed by Urodynamic Studies measuring the Urethral closure pressure UCP. This involves a catheter being inserted into your urethra. There are several other indicators in the client history and symptoms which will help the Women’s health physiotherapist with this diagnosis.
Prevention – maintenance of good pelvic floor muscles
- Local oestrogen in vaginal cream or pessary long term.
- Alpha adrenergic agonists—these drugs may stimulate the sphincter.
- Injection of peri-urethral bulking agents e.g. Macroplastique.
Success, however, is limited making prevention even more important.
The absolute 1st line of action or “best practise” medicine is to try and strengthen your Pelvic floor muscles. Most GP’s, Gynaecologists and Urogynecologist’s will advise their patients to try 3-6months of Pelvic floor muscle education and re- training before surgical intervention.