Disease Description (Causes and Symptoms)
- Definition: Stress urinary incontinence is a condition in which urine leaks because the urethra does not close properly when intra-abdominal pressure increases, such as with coughing, sneezing, or exercise.
- Pathophysiology: Weakening of the pelvic floor muscles and supporting tissues reduces urethral support, or the function of the urethral sphincter (intrinsic sphincter function) declines, resulting in insufficient urethral closure when intra-abdominal pressure rises. Urethral hypermobility (urge urinary incontinence) may also be present.
- Main causes
- Women: Pregnancy and childbirth (especially multiple deliveries and vaginal delivery), menopause (estrogen deficiency), pelvic organ prolapse (uterine or bladder prolapse), urinary tract infection or vaginitis, chronic cough, obesity, constipation
- Men: Damage to the urethral sphincter or pelvic nerves due to radical prostatectomy or other causes
- Symptoms
- Sudden leakage of a small to large amount of urine during coughing, sneezing, laughing, or exercise
- Possible accompanying symptoms: urinary frequency, nocturia, urinary urgency, foul-smelling or cloudy urine, and dysuria (in cases of urinary tract infection)
- Severity varies among individuals and may affect daily life (social discomfort and activity limitations)
- Useful tests for diagnosis (summary)
- Medical history and physical examination (observing leakage when intra-abdominal pressure is induced), a 3-day bladder diary, urinalysis (to check for infection)
- Pad test (evaluation of the amount of urinary incontinence), uroflowmetry and post-void residual measurement, urodynamic testing (if necessary)
Treatment Methods and Precautions
- First-line nonsurgical treatment (recommended as the priority)
- Pelvic floor muscle strengthening exercises (Kegel exercises): contract for 5–10 seconds and then relax, 10 repetitions per set × several sets per day (consistency is key). Several weeks to several months of training may be required.
- Biofeedback: helps confirm correct muscle contractions and assists with training
- Electrical stimulation and extracorporeal magnetic stimulation: may help by stimulating the pelvic floor
- Behavioral therapy: weight loss, correction of urination habits (bladder training), moderation of caffeine and alcohol, treatment of constipation, and treatment of cough (including smoking cessation)
- Topical estrogen (for menopausal women): may help improve symptoms when vulvar or vaginal atrophy is present
- Medication
- Medication often cannot provide a fundamental cure. Some medications (e.g., duloxetine) may help improve symptoms by increasing urethral sphincter tone, but side effects and indications must be considered.
- Procedural and surgical treatment (when symptoms persist or conservative treatment fails)
- Midurethral sling (insertion of synthetic tape under the mid-urethra, such as TVT/TOT) — a standard surgery widely performed in women
- Traditional urethral support surgery (surgery to elevate the bladder neck through an abdominal or vaginal approach; when necessary)
- Urethral bulking agent injection: may be considered in mild cases
- Men: male sling or artificial urinary sphincter (for severe urinary incontinence)
- If complications related to synthetic tape (such as infection, vaginal wall erosion, or pain) occur, removal may be necessary
- Precautions and complications
- Possible postoperative infection, foreign-body-related complications, voiding dysfunction, pain, and recurrence
- If a urinary tract infection is suspected, it must be treated first
- The choice of treatment is determined by considering age, plans for pregnancy, symptom severity, and comorbidities (e.g., neurological disease)
Checklist Before an Outpatient Visit (Including Preparations and Sample Questions)
- Items to prepare
- A list of currently used medications (prescription drugs, over-the-counter medicines, and supplements)
- History of previous surgeries and deliveries (number of deliveries, methods, and complications), and other medical history (diabetes, neurological disease)
- Recent urinalysis, uroflowmetry, urodynamic testing, and other test results (if available)
- A 3-day bladder diary (urination times, urine volume, times when leakage occurred, and amount of pad use)
- The usual number of pads used and approximate amount of leakage, as well as when symptoms began and how they have progressed
- Whether pregnancy is planned and any problems related to sexual activity (if necessary)
- Questions to prepare to tell or ask the doctor during the consultation (examples)
- When does leakage occur (during what activities)?
- How much urine leaks (number of pads/time between changes)?
- Are there symptoms of infection, such as dysuria, hematuria, or fever?
- Have you tried any exercises or treatments previously, and how effective were they?
Examples of General Questions to Ask the Doctor
- "What is the most appropriate first-line treatment for my symptoms?"
- "What are the expected effects and side effects of this medication (or procedure)?"
- "How likely is it that my symptoms will improve with nonsurgical treatment? How long must I continue it before seeing results?"
- "What are the advantages and disadvantages of surgical treatment, and what is the recovery period?"
- "What is the likelihood of recurrence or risk of complications after surgery?"
Examples of Condition-Specific Questions
- Women (of childbearing age or planning pregnancy): "I am planning a pregnancy. When would be the best time to consider surgery in relation to childbirth? How might pregnancy and childbirth affect the treatment results?"
- Men (urinary incontinence after prostate surgery): "I have urinary incontinence that developed after radical prostatectomy. In my case, which treatment is more suitable: a male sling or an artificial urinary sphincter? What treatment results and complications can be expected?"
(If necessary, bringing a bladder diary form and test results to the appointment can help with diagnosis and treatment planning.)