I put this site up because I found it difficult to get a simple overview. Everywhere I looked there was some sort of sales pitch or over technical information. This page is simple, in lay language, and here to help you understand the issue. I am not a doctor and you need to consult your Doctor before taking any action. I left out specific exercises and remedies because I want you to go see your Doctor. Read this page so you have enough knowledge going into the appointment. But your Doctor will know what is best for you. If you take nothing away from the information I have provided take this – You do not have to live with this problem. Take action. Do not allow it to affect your life forever.
Definitions
Incontinence – An involuntary loss of urine, in other words leaking urine. The severity of the problem can range from a minor inconvenience to an level where the urine causes social and/or sanitary consequences. This condition affects over 10 million men and women in the United States .
The word “stress” directly relates to a situation where the muscles are in a weakened state and therefore are “stressed” beyond their capacity to hold in the urine present in the bladder. When the muscles are tending to other activities such as laughing, sneezing, coughing, etc – they release their hold on the bladder to perform other functions. When the muscles are strong and healthy they can perform multiple functions – in other words they can perform properly when under multiple function stress. But when they are in a weakened state they cannot handle multiple functions. Hence when they are stressed they involuntarily allow some urine to be released.
The Basics
Sounds like a terrible situation doesn’t it? Well lets face it no one wants to have any kind of Incontinence. But the question is – what the heck is it anyway? Well its pretty simple – it can range from a little “oops” to a major “wetting”. What do I mean by that? It’s an involuntary loss of urine. Most people over 40 have had it happen a little here or there but not as a common occurrence. So now we know what incontinence is (remember it’s that little involuntary loss of urine) what is stress incontinence? It’s simple – it’s when you have a little loss of urine due to some sort of “stress” on the muscles, urethra, abdomen, somewhere that has an affect on the urine. I originally thought it was loss of urine when you are under stress – that would be all you need. You get stressed (mentally) and then you lose urine control. What a terrible thing that would be – what if you got stressed about the stress? Anyhow that’s not what it is – when you stress the muscles that hold the urine in – such as when you cough, laugh, sneeze, or do any other sort of physical activity that causes your muscles to focus on other activities than holding the urine. So let us review this a little. Stress incontinence is when the muscles are stressed in some way. What exactly does this “stress” mean? We know from the above paragraph it is caused from laughing, sneezing, exercising etc – but how does that relate? Well if you really must know lets cover it….
The Simple Biology: Because incontinence is the involuntary loss of urine lets talk a little about how all this happens. The body stores urine in the bladder (this is why sometimes though rare it is a symptom of possible bladder cancer) and the urine exits the body through the urethra. In between times that we urinate our body slowly fills the bladder. Think of it this way – the body slowly drips urine into the bladder – when the bladder is full we urinate. The body has muscles that hold the urine in the bladder. These are the muscles that feel very strained when you “really have to go”. Under normal circumstances these muscles hold the urine in without conscious effort. Just as our heart pumps without conscious effort. So now lets suppose you have some urine in your bladder. This is normal because the body is always dripping urine into the bladder in between times we urinate. When you stress you intra-abdominal muscles. Yes, a big word for the muscles within your abdominal area. If the muscles are weak or not functioning properly – they will release their hold on the bladder to perform another function. In essence the muscles, because they are weakened, cannot “multi-task”. When they are asked to hold in urine and cough for example – they can only do one function – hence they release their hold on the urine in the bladder in order to perform the task of the cough. The weaker the muscles and the amount of urine in the bladder at the time determines the amount of involuntary urine loss.
Myths
1. Incontinence is unavoidable and I have to learn to live with it. This is entirely untrue, at least on the surface. There are many treatments and solutions. The most important thing to do is to see your Doctor. Do not just start wearing Depends undergarments and ignore the problem. Go to the Doctor and work on fixing the problem. You do not necessarily have to live with this condition.
2. Incontinence is no big deal.The fact is that it is a big deal. Anything that makes you change your life patterns or wear special clothing is something worth fixing. Take charge and go see your Doctor. Do not just “live with it”.
3. Incontinence only happens if you are weak.This is untrue so face it, admit it, and then address it. Ignoring it is not the answer. It does not make you less of a person and it is not “admitting you are old”. Get over yourself and get in to your Doctor.
4. I have tried the exercises and they do not work.Really? Well then see your Doctor and research other alternatives. Maybe your problem is not from weakened muscles. Maybe there is another cause. Get your self checked out and seek second even third opinions. The most important thing is to not resign yourself to suffering for the rest of your life. Fight it.
5. Why see a Doctor I will self exercise and self medicate.That is the wrong attitude. Go see the Doctor so they can look into your organs to make certain the problem is not a symptom of a larger problem. They also have FDA approved medication that may help. They also will have the most up to date advice for you. Go see your Doctor because it is the right thing to do. Do not be embarrassed. Find out your Doctors advice.
Surgery
There are times when the simple remedies such as exercises and prescriptions do not effectively cure you. This is when you may want to consider one of the many surgical options. These options are being used more often than in the past but are certainly a last resort.
There is no harm in asking your Doctor about the alternative and getting a referral to a specialist. These specialists can do much more specialized testing and determine other non surgical treatments but also surgical treatment recommendations.
There are a few reasons you may want understand should you be considering the surgery option:
1. Always get a second opinion before any surgery.
2. Unless there is some other medical reason exhaust the other treatments before opting for surgery.
3. Sometimes surgery can make things worse if things do not go well. Fully evaluate your condition physically, physiologically, socially before proceeding to surgery
4. If the underlying cause of your problem is nerve damage remember that the surgery can mitigate this issue but not regrow the nerves. Be certain you fully understand the benefits vs risks of the surgery as well as the specific surgical remedy that is being proposed.
5. A surgery can cure one type of incontinence but leave you with another. 6.Surgery may affect you sexually.
As of 2010 there are primary only 2 types of incontinence surgeries. This part is starting to get technical – but if you are considering a surgical option it is good information for you to know.
The first is a set of surgeries that vary from each other but all fall under the heading of Sling Surgery.
Sling Surgeries.
Basically the doctor adds a sling or extra tissue to the head of the bladder making it shut more easily. This would of course reduce the accidental opening and release of urine when under stress. These sling procedures actually are very likely to work well for many patients. The success is very high.
Slings without tension.
This is a sling that is made up of some synthetic material. It is lodged in place amongst your flesh without stitches. The body then forms scar tissue around the mesh making it more solid and secure so it will stay in place. These are highly effective with the most common but still rare side affects of some infection and/or pain. There are two ways they make these slings without tension work. The two ways are known as retro (supra) and transobturator. The technical specifics of these two procedures are more than many people will even want to know. Just know that both are made without stitches and both are considered highly effective. The transobturator procedure is the newer of the two procedures and basically means the surgeon reaches the bladder through the pubic bone area, with the retro procedure, or through the labia with the trans procedure. The problem with the new procedure is just that. It is new so long term there are no studies to show the effectiveness. It is also worth noting that there are some slings that are adjustable where the surgeon can make adjustments as years pass and then there are convention where the surgeon makes on insertion that cannot be changed. Once again we come down to the fact that the adjustable slings are newer and have not had long term studies whereas the conventional slings are tried and proven. The material for the sling procedure is usually synthetic but sometimes it is materials from animals or cadavers. The sling procedure is the less invasive of the two procedures. Normally there is a 14 day to 42 day recovery time and the procedure can oftentimes be performed on an outpatient basis.
Hold The Neck Of The Bladder Surgery
The second type of surgery is where they suspend the neck of the bladder. This is a relatively simple procedure but it is very invasive and certainly leaves a scar on your abdomen. The doctor goes through your abdomen straight to your bladder and stitches your bladder in place. Thus “suspending” or “holding” it into place. This holds it up so that it is much less likely to leak when under stress. In other words eliminate the problem. The reason people opt for the sling surgeries is because while the sling surgeries can be done as an outpatient. The suspension surgery is done under full anesthesia and is a full on operation. This means recovery is much longer – at a minimum of 42 days and during this time you will likely need to use a catheter. For many the use of the catheter for 6 weeks is enough reason for them to opt for the sling surgery. Especially men.
If Surgery simply scares you – Consider this. It is possible in some cases to inject material such as collagen into the tissue surrounding the bladder neck in order to hold it in place. Remember that the surgeries are mostly strengthening these areas. If you can get the collagen to suspend the neck of the bladder then in essence you are getting the same result without surgery. Of course there is a downside. That is that the material they inject, for instance collagen, breaks down over time. So your incontinence will slowly return again over about a year and a half. The good news is the procedure is simple and takes about an hour. This surgical alternative has been under development for years and is not yet commonplace. But it is gaining more and more acceptance in the urological community. I mentioned above they oftentimes use collagen injections. While this is true it is not an absolute. I like the idea of collagen because collagen is a natural substance already found in your body. I would rather have something natural injected in to my body. But some people are allergic to collagen injections just the same. So not everyone can use collagen. They are also experimenting with carbon zirconium materials and other synthetics. But collagen is the most commonly used. Either way this is a problem that is with us. And as such a large demographic in society reaches the ages where incontinence will be more common then surely more advancements and cures will be made. Always consult your doctor and keep your eyes open for new developments. I sincerely hope this overview of stress incontinence has helped you. I basically researched all the medical information I could find. Consulted others. Then compiled this site to help those experiencing problems. I thought it was important for there to be a resource that was not a sales pitch for a product or service. Just a sincere overview of the issue.
I hope it helps.
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