1) Disease Description (Causes and Symptoms)
- Definition: Stress urinary incontinence is a condition in which urine leaks involuntarily when intra-abdominal pressure rises due to coughing, sneezing, laughing, exercise, or similar activities.
- Pathophysiology: It occurs when the urethra cannot close properly as intra-abdominal pressure rises because the support or contractile strength of the pelvic floor muscles and urethral sphincter has weakened. In women, weakening of the pelvic tissues (such as due to pregnancy, childbirth, menopause, or uterine prolapse) is a major cause, while in men, urethral sphincter damage (for example, after radical prostatectomy) may be the cause.
- Main causes: Pregnancy and childbirth, hormonal changes due to menopause, history of pelvic surgery, urinary tract infection or vaginitis (aggravating factors), obesity, chronic cough or constipation, and nerve damage (such as spinal cord injury).
- Main symptoms: Leakage of a small to large amount of urine when intra-abdominal pressure rises, such as during coughing, sneezing, running, or lifting heavy objects. Storage symptoms such as urinary frequency, nocturia, and urgency may also occur. If lower back pain, painful urination, blood in the urine, or a foul odor is present, other causes, including an accompanying infection, should be suspected.
2) Treatment Methods
- Nonsurgical treatment (first-line)
- Pelvic floor muscle strengthening exercises (Kegel exercises): Symptoms may improve when performed correctly, regularly, and continuously. In general, contracting and relaxing the muscles for 5–10 seconds 10 times per session, several sets per day, is recommended.
- Biofeedback, electrical stimulation, and extracorporeal magnetic stimulation: Adjunctive treatments that help improve the effects of pelvic floor exercises.
- Lifestyle modification: Weight loss; limiting bladder-irritating foods and beverages such as caffeine, alcohol, and carbonated drinks; treating constipation and chronic cough; and improving voiding habits (such as urinating regularly).
- Local vaginal estrogen (in cases of menopause or atrophy): May improve symptoms in some patients by improving the condition of the urethral and vaginal mucosa.
- Medication: In women, the effect of medication as a definitive treatment is limited. In some countries and situations, duloxetine is used to relieve symptoms, but side effects and approval status vary by country. Consultation with a doctor is necessary.
- Interventional and injection treatment
- Injection of a urethral bulking agent (under the urethral mucosa): May provide short-term improvement in cases of mild symptoms or when surgery is not desired (the duration of effectiveness is limited).
- Surgical treatment (when symptoms persist, are moderate or severe, or conservative treatment fails)
- Midurethral sling (important): An artificial tape (mesh) is inserted under the midurethra to support the urethra. Approaches include the retropubic route (toward the abdominal wall) or the groin direction (transobturator route, such as TVT/TOT). It has a high success rate. If mesh-related complications (infection, erosion, or pain) occur, removal may be necessary.
- Other: Pelvic reconstructive surgery (when prolapse is also present); in men, sling surgery or insertion of an artificial urinary sphincter (particularly for severe urinary incontinence after prostatectomy).
- Postoperative lifestyle management and precautions
- During the recovery period, it is necessary to follow instructions such as limiting lifting heavy objects, strenuous exercise, and sexual activity (follow the doctor's instructions).
- Immediate medical attention is necessary if infection, bleeding, urinary retention, or mesh-related complications occur.
3) Checklist Before an Outpatient Visit (Including Recommended Items to Bring and Example Questions)
- Recommended items to bring
- A list of medications currently being taken (including prescription drugs, over-the-counter medications, and health functional foods)
- History of previous surgeries and childbirth (cesarean section/vaginal delivery, number and timing of births)
- Recent test records (urinalysis, urine culture, pelvic ultrasound, previous urodynamic test results, etc.)
- A bladder diary (3 days recommended): voiding times, urine volume, timing of urinary leakage, and amount of fluid consumed
- Pad use (number of pads used per day/degree of wetness)
- When symptoms began and situations that trigger them (for example, coughing or climbing stairs)
- Information to confirm during the outpatient visit (organizing this in advance can help with the consultation)
- Symptom patterns (when and during which activities urine leaks), and accompanying symptoms (painful urination, blood in the urine, or fever)
- Impact on daily life (social or occupational limitations)
- Previous treatment attempts and their results (Kegel exercises, physical therapy, medication, surgery, etc.)
4) Examples of General Questions to Ask the Doctor
- "How likely is it that my symptoms will improve without surgery?"
- "What are the expected benefits and side effects of each treatment (exercises, medication, and surgery)?"
- "If I choose surgery, how long will the recovery period be, and when can I return to my daily activities?"
- "How likely is recurrence, and what treatments are available if it recurs?"
5) Examples of Disease-Specific Questions
- Pregnancy and childbirth: "I am planning to give birth. What treatment is safe and recommended for my current symptoms? When is it best to start treatment after delivery?"
- Men after prostate surgery: "For urinary incontinence that developed after radical prostatectomy, which surgery is more appropriate for my situation—a sling procedure or an artificial urinary sphincter? What are the advantages and disadvantages?"
Note: If blood in the urine, severe painful urination, or fever accompanies the symptoms, prompt testing is necessary because a urinary tract infection or another underlying organic problem may be present. The actual choice of treatment should be based on a specialist's judgment, taking into account the individual's age, comorbidities, symptom pattern, and surgical history.