Effort incontinence: is it curable?

Stress urinary incontinence (SUI), also known as effort incontinence, is essentially due to insufficient strength of the pelvic floor muscles. It is the loss of small amounts of urine associated with coughing, laughing, sneezing, exercising or other movements that increase intra-abdominal pressure and thus increase pressure on the bladder. The urethra is supported by fascia of the pelvic floor. If this support is insufficient, the urethra can move downward at times of increased abdominal pressure, allowing urine to pass.
In women, physical changes resulting from pregnancy, childbirth, and menopause often contribute to stress incontinence. Stress incontinence can worsen during the week before the menstrual period. At that time, lowered estrogen levels may lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause, similarly because of lowered estrogen levels. In female athletes, effort incontinence occurs in all sports involving abrupt repeated increases in intra-abdominal pressure.

Causes
SUI is due to weakness in the pelvic floor muscles that support the organs in your pelvis and abdomen and the sphincter muscle that keeps the bladder outlet closed. If they aren’t strong enough to support your bladder, the sphincter opens slightly and urine leaks out.
The most common causes of SUI are:
nPregnancy: Carrying the increasing weight of baby in your pelvis over 40 weeks puts extra stress on your pelvic floor.
nChildbirth: If you have a vaginal delivery, it’s possible the nerves around your pelvic floor become stretched and bruised. After delivery, they can’t make the pelvic floor work properly and the muscles may not respond as well.
nMenopause: Lowered estrogen levels weaken the sphincter muscle and the pelvic floor.
nPelvic surgery: May also make your leakage worse for different reasons.
 
Symptoms
The most common symptoms and causes are:
nLeaking when you laugh, cough, sneeze or exercise. This is likely to be stress urinary incontinence (SUI), when the pelvic floor can’t hold the bladder outlet shut.
nA sudden and compelling need to pass urine that you can’t hold (urgency), and/or visiting the toilet more than once every couple of hours (frequency) or during the night (nocturia). This is likely to be urge urinary incontinence, when the muscle in the bladder wall is unstable.

Some myths about SUI
nMyth: SUI is a normal part of the ageing process.
Fact: Experts estimate that one in three women get SUI at some point in their lives. However, SUI can affect women of any age. Although it is more common in women between the ages of 35 and 60, it is not a normal part of ageing. The weakening of the pelvic floor, connective tissues and muscle can happen as a result of pregnancy and childbirth, chronic heavy lifting or straining, menopause or obesity.
nMyth: SUI is a temporary disorder that cures itself.
Fact:  SUI is not a temporary condition and if left untreated for long, the condition can worsen.
Dr Jyoti V Shenoy discusses treatment options that are now available.
nMyth: Medication is better than surgery for treating SUI.
Fact:  Doctors decide whether to recommend surgery or prescribe medication based on a patient’s medical history and the severity of the disease. While medication is used for disease management, surgery offers a permanent cure to the problem.
nMyth: Surgery to cure SUI impacts a woman’s sexual relations.
Fact: There are various surgery options available to treat SUI such as TVT (Tension-free Vaginal Tape) and bladder neck suspension surgery among others to cure SUI. None of the surgeries for SUI impact a woman’s sexual relations.