Recurrent stress incontinence. Causes and treatment in the female patient

Recurrent urinary incontinence after surgery requires complete evaluation, including urodynamic testing, to make an accurate diagnosis. Documented genuine stress incontinence, if mild to moderate, may respond to nonsurgical treatment, but more severe cases require surgery. Numerous effective surgical procedures have been developed.     

Understanding stress urinary incontinence

Underreported and undertreated, stress urinary incontinence leads to decreased quality of life in sufferers and financial burdens for both the patient and the healthcare industry. Nurse practitioners should understand their role in identifying, diagnosing, and treating the condition.     

Treatment of stress urinary incontinence

This review presents reported cure and improvement rates of stress urinary incontinence in women obtained by different treatment modalities. Apart from the urodynamic findings, histological and histochemical changes of the pelvic floor may be clinically relevant to treatment in the future. Long-term cure and improvement rates achieved by non-surgical treatment (physiotherapy, biofeedback, bladder training, electrostimulation) are commented on. These rates range from 40-60% for physiotherapy and electrostimulation but are considerably less after biofeedback and bladder training. Pharmacotherapy is unlikely to offer more than a placebo effect. Studies of a single surgical procedure usually report high cure rates. In making the appropriate choice of operation the best guidelines are the cure rates from comparative or prospective randomized reports. From such studies an abdominal retropubic suspension operation (cure rates after five years 57-78 %) is more likely to help the patient than an anterior colporrhaphy (cure rates 31-70 %) or a transvaginal needle bladder neck suspension (cure rates 39-61 %). In selected patients sling procedures or the use of artificial sphincters may produce excellent results (70-80 %). To estimate the results of different treatments urine loss should be assessed objectively and physical restrictions and hygienic and social implications taken into account. A method of pre- and post-treatment "performance scores" should be developed.     

Treatments for stress urinary incontinence

Stress urinary incontinence (SUI) is a common problem among women, particularly after childbearing. While it is not in itself life-threatening, it inevitably impairs quality of life, causing embarrassment and even social isolation--this is often both the reason that people with SUI seek medical help and the method of measuring the success of treatment. A range of treatment and management options is available for dealing with this distressing condition.     

Managing stress incontinence in postnatal women

Urinary incontinence can have a significant impact on quality of life. This article explores the causes of stress urinary incontinence, and the impact of childbirth in particular, and discusses the importance of thorough assessment and treatment options.     

Vaginal cones in stress incontinence treatment

Jeanette Haslam explains the theory that underpins the use of vaginal cones in stress urinary incontinence and how this translates into practice.     

胶原蛋白与压力性尿失禁

压力性尿失禁(Stress Urinary Incontinence,SUI)在中、老年妇女中较高的患病率,影响了她们的生活质量.SUI的发病机制比较复杂,其中整体理论详细阐述了盆底结缔组织对维持正常控尿的重要作用.胶原蛋白是盆底结缔组织的重要组成部分,其合成与降解影响盆底结缔组织的形态和功能.SUI患者可能由于胶原蛋白合成减少和(或)降解增加,使盆底结缔组织的弹性和韧性受到影响,从而引发尿失禁.     

Functional imaging of stress urinary incontinence

Stress urinary incontinence (SUI) is defined as an involuntary loss of urine during increases in intraabdominal pressure such as coughing or laughing. It is often a consequence of weakness of the pelvic floor. Treatment of SUI consists of pelvic floor muscle training with EMG-biofeedback (PFMT) or contraction-exercises, with voluntary pelvic contractions in order to strengthen the pelvic floor. We investigated neuroplastic changes comparing PFMT with EMG-biofeedback before and after training in ten female patients with SUI using event-related functional Magnetic Resonance Imaging (fMRI). After a 12-week training a more focused activation in the primary motor and somatosensory cortical representation sites of the lower urogenital tract was found. In addition, reductions in brain activation in the insula, right frontal operculum and the anterior cingulate cortex suggest changes in emotional arousal in micturition after treatment. These changes are related to clinical improvement documented by decreased number of incontinence episodes and increased EMG-activity of the pelvic floor muscles after training. The changes in EMG-activity were correlated with heightened BOLD responses in the primary motor and primary sensory cortical representation sites of the lower urogenital tract.     

Why women leave therapy for stress incontinence

Stress urinary incontinence (SUI) is the involuntary leakage of urine associated with effort, exertion, sneezing or coughing (Abrams et al, 2002) and is the most common type of incontinence in women (Hampel et al, 2004). In 2005, NHS Greater Glasgow introduced a primary care management of SUI pathway. However, a high percentage of patients failed to complete their therapy.The aim of this study was to explore why some women with SUI dropped out of the pathway.     

Reeducative treatment of female genuine stress incontinence

Three-months re-education treatment of genuine stress incontinence was given to 26 female outpatients: 22 patients completed the treatment programme and 4 interrupted it for various reasons. The aims of the treatment were both to correct compensatory habits that patients used to conceal or reduce leakage accidents and to give specific education and strengthening of pelvic floor muscles. All patients who completed the three-months treatment definitely improved and 7 were cured. Accordingly a marked reduction or absence of weekly incontinence episodes as well as a reduction of the daily frequency of micturition was observed. On vaginal palpation a clear-cut improvement of pubococcygeous muscle contractility was detectable. Urethral closure pressure profilometry showed significant improvement of functional urethral profile length at rest and of maximal urethral closure present both at rest and during maximal voluntary contraction of the pelvic floor muscles. Micturition cystourethrography, repeated in 15 patients at the end of the treatment, showed a clear-cut improvement of bladder neck suspension defects in all but 2 patients. Follow-up assessments showed that the clinical effects were long-lasting. Possible mechanisms of this re-educative technique are discussed.