What is it?
Firstly, Stress Urinary Incontinence has nothing to do with anxiety or the emotional type of stress. It refers to urinary incontinence that occurs during some type of physical stress or exertion such as a cough, sneeze, run, jump, sport etc. These events raise abdominal pressure and this pressure on the bladder results in leakage of urine, which should not occur normally. In some patients it is so severe that they can leak with minimal exertion or movement like even walking, stepping up the curb or getting out of the car. Government Patient Information Resource https://www.safetyandquality.gov.au/wp-content/uploads/2017/02/FINAL-Patient-information-resource-transvaginal-TV-mesh-Stress-Urina....pdf
New South Wales government has produced a document as a decision aid for treatment for Stress Incontinence and a summary document.
What causes it?
It results from a weakness of the pelvic floor muscles or urinary sphincter muscle, (intrinsic sphincter deficiency), or both. Child birth, age, straining, coughing, lifting, obesity, and genetic predisposition may all contribute.
What tests are required?
Beyond a history and examination very few investigations are required for a patient who only has stress incontinence symptoms. A urine test is the main test to help rule out other causes like an infection. A bladder diary is also helpful in assessing for other problems. Sometimes ultrasound is used to check bladder emptying if there are also symptoms to suggest a problem with emptying. Urodynamics is the main test for patients failing non-surgical therapies (such as pelvic floor exercises) and considering surgical options. The history and examination findings may not always lead to the correct diagnosis and this test helps confirm the diagnosis before proceeding with surgery and also detects other problems that may co-exist and influence treatment choice.
What is mixed incontinence?
Patients with Stress Incontinence may also have other problems such as Overactive Bladder (Urge Incontinence). Then both conditions may require different treatments.
What are the non-surgical treatments?
- Pelvic Floor Exercises: (These do not require getting on the floor.) The muscles that support the bladder and urethra are called the ‘Pelvic Floor Muscles’. Continence Nurses and Physiotherpists can help with these.
- Weight reduction in overweight patients.
- Good diet and bowel function.
What are the surgical options?
- Injectable agents – substances such as carbon (Durasphere) polymer (Bulkamid) are injected into the wall of the urethra. This can even be performed under Local Anaesthetic. Silicone can also be used but can cause problems with erosion and difficult to perform with local anaesthetic.
- Mid Urethral Slings – mesh slings (tapes) placed around the urethra.
- Fascial Slings – a bladder neck sling made from the patient’s own tissue (fascia). Often recommended in more severe incontinence especially when intrinsic sphincter weakness (Type III).
- Colposuspension – vaginal tissue is sutured to pelvic ligaments to elevate the bladder neck.
- Synthetic Male Slings - usually used for treating stress incontinence resulting from prostate surgery.
- Atrificial Urinary Sphinter - for severe incontinence and used more commonly in men after prostate surgery than in women.
Is there government funding for pads?
Financial support is available for patients, with severe incontinence, who qualify under the government Continence Aids Payment Scheme (CAPS). Your local GP or our Continence Nurse or Continence GP's can assist with completing these application forms.
Version: V6, September 2018