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By Dr Bob Ochila
Stress urine incontinence (SUI) is the involuntary leakage of urine caused by an increase in pressure exerted on the bladder. The bladder is pushed downwards as a result of normal increases in abdominal pressure, as may occur when we laugh, cough, sneeze, or do exercise. This should ordinarily not result in urine leakage if the bladder has a properly functioning sphincter (The sphincter is the ring of muscle that closes the opening of the bladder). The term “stress” in this context has nothing to do with an individual’s psychological state or emotion but rather refers to the forces exerted on the bladder in normal situations that, for some individuals, result in urine leakage.
Stress incontinence is very common in women. The condition is important as it negatively impacts quality of life. Affected women often need to be careful in social gatherings due to fear of an accident and embarrassment. They must carefully choose clothing to mask accidents. They may also have to wear continence pads. Many patients have to sadly stop engaging in activities they love, such as sports or gym attendance. Relationships and intimacy are often negatively impacted, as is productivity at the workplace.
Many women have SUI during pregnancy and immediately after childbirth. This invariably tends to improve with time. However, for some, the condition can persist. SUI also increases with advancing age, especially after the menopause. Medical conditions, surgery, some forms of treatments (e.g., radiotherapy for cancer), and rarely infections that result in scar tissue formation can result in SUI. Obesity and unhealthy lifestyle have been associated with SUI. For some patients, the cause is unknown. SUI is generally rare in men.
The typical patient with SUI will complain of leaking urine or wetting a pad while laughing, sneezing, or coughing. There might also be urine leakage when doing physical activities such as exercising or lifting a heavy object. Some patients have more than one type of incontinence (mixed incontinence). Other bladder problems might also mimic stress incontinence. It is, therefore, important to inform your doctor if you have any other bladder symptoms such as pain or discomfort when the bladder is filling, delays before you start to urinate, a slow or weak urine stream, or a feeling of incomplete bladder emptying. The doctor has to take a careful history and do a few investigations to confirm that the patient has SUI.
SUI is easily treatable. As earlier mentioned, if you are currently pregnant or recently had a baby, you can expect improvement with time as your tissues heal and get back to normal. Many patients can benefit from lifestyle modifications and healthy living, including weight reduction if they are obese. Since the problem is due to a weakness of the sphincter mechanism, pelvic floor exercises (Kegel’s) can help a lot. There are many types of highly effective surgeries that can cure SUI. A typical surgery for SUI is done as a “day case,” where the patient comes into the hospital and leaves for home the same day.
Many women in Kenya might not seek medical help for urine incontinence due to social stigma and embarrassment. There is also the misconception that leaking urine is a normal and inevitable part of aging. Many women often get confused about where to seek help for this problem or might doubt if there is any effective intervention available. The good news is that SUI is one of the most treatable forms of urine incontinence, where the aim is complete cure. Recently, I received a message from one of my patients after treatment for SUI. She was ecstatic that she had started her workouts at the gym again, and for the first time in years, she could run without leaks. It was a good feeling that the treatment had such a positive impact on her life.
Dr. Bob Achila is a consultant Urogynaecologist at the Aga Khan University Hospital
