Urinary incontinence is the involuntary leakage of urine. Although it's commonly associated with geriatric health issues, this isn't just something that affects the elderly. For instance, it's more common among women than men – yet regularly used women's treatment plans often prove suboptimal.
There are a few major types of urinary incontinence, including urge, stress, and mixed. With stress urinary incontinence (SUI), caregivers and patients have access to a wide range of treatment options, but it's vital to get the diagnosis right first – and urological medicine plays a major role in effective treatment.
Stress Urinary Incontinence Basics
The mechanism of stress urinary incontinence (SUI) involves two muscles collectively known as the urethral sphincter. This set of muscles controls the passage of urine. Both males and females have an internal urethral sphincter, but the external urethral sphincter muscle is differentiated in males and females.
Stress incontinence is typically characterized by incontinence incidents preceded by physical stressors. For instance, it can happen when movement or activity puts pressure on the bladder and causes urine leakage. Some common triggering activities may include coughing, sneezing, laughing, lifting motions, exercise, and other actions associated with heightened intra-abdominal pressure.
Risk Factors
Some behavioral risk factors associated with SUI include smoking, diabetes, and high caffeine intake. More women than men suffer from stress incontinence due to their heightened exposure to gender-specific risk factors. For instance, SUI often occurs after childbirth, menopause, or surgery, and it may become more severe before menses – changes in estrogen levels have been implicated in increasing the likelihood of leakage.
Treatments
While some patients may enjoy success after undergoing bladder training, starting weight loss programs, or modifying contributing lifestyle behaviors, like quitting smoking, these solutions aren't universal fits. In more severe cases, a doctor may recommend bladder training, medication or even one of several different surgical procedures. Unfortunately, some of the surgical options geared towards women, such as mesh insertions, can have lasting side effects that may contribute to a lowered quality of life.
So how do patients and their caregivers typically choose the best route forward in cases of suspected SUI? Diagnosing the problem accurately and thoroughly plays a big part.
The Diagnostic Connection
One of the tricky aspects of SUI is that it shares its most obvious symptom, urine leakage, with other conditions. When it comes to general urinary incontinence, it's not always easy for patients to tell which of the main variants – urge, overflow, stretch, or mixed – they're really dealing with.
Even when patients believe their leakage may have been prompted by a specific event, it's imperative to narrow down the problem, particularly in the preoperative evaluation context. Self-reported symptoms and clinical histories haven't proven themselves as wholly accurate means of diagnosing SUI. For instance, urge incontinence may occur following common triggers like cold exposure, cold beverage consumption, or even hearing the sound of running water, making it tough to untangle these patient accounts from SUI events.
Potential harm minimization is also worth considering. Although it's extremely common for patients to end up going the surgical intervention route, the associated outcomes are less predictable than the method's prevalence would seem to warrant.
The Urodynamics Role
Diagnostic tests that include urodynamics may help physicians and patients avoid undesirable outcomes by revealing an enhanced scope of data on how specific incontinence cases manifest.
On the other hand, not everyone's on the same page. Though urodynamics commonly plays a role in preoperative SUI evaluations, some older studies, like 2012's oft-cited A randomized trial of urodynamic testing before stress-incontinence surgery, have suggested they don't contribute to improved outcomes.
It's worth digging deeper. For instance, that particular study didn't address women whose histories included events such as prolapse or recent incontinence surgeries. It also excluded those patients for whom SUI wasn't the predominant type of incontinence they faced.
Urodynamics is a type of medical testing typically performed by a nurse after being ordered by a urologist, gynecologist, OB/GYN, or primary caregiver. It essentially works to help answer questions about how the bladder and urethra function in a holistic way.
Urodynamic testing incorporates a range of different empirical techniques. For instance, a doctor or nurse may insert a small, high-sensitivity catheter into the bladder to measure urine flow and pressure. In some cases, practitioners employ high-fidelity X-rays or ultrasound to visualize the urinary tract in real-time and observe how the muscles move in response to pressure and other stimuli.
Promoting Better Stress Incontinence Diagnoses
Caregivers typically confirm their diagnoses of stress urinary incontinence by attempting to positively identify symptomatic or asymptomatic overactivity of the detrusor – a smooth muscle in the bladder wall. Problematically, detrusor overactivity itself can contribute to mixed symptoms and increased diagnostic confusion. The detrusor overactivity approach may also ignore many other important variables, including:
- Detrusor under-activity,
- Bladder outlet obstruction,
- Pelvic organ prolapse, which commonly occurs alongside SUI, and
- Degree of stress urinary incontinence severity.
Urodynamics helps clarify things by individually assessing the many factors that might impact each patient. For instance, some women who suffer from SUI also report urge incontinence – the feeling of needing to frequently urinate accompanied by leakage.
In a percentage of urge incontinence sufferers, there may not be detrusor overactivity, but there might still be an intrinsic sphincter deficiency to make up for it. In many cases, it's difficult to tell which of the two, sphincter deficiency or detrusor overactivity, is behind the problem – highlighting the importance of considering the existence of multiple underlying SUI causes.
Urodynamic exams may make it easier to differentiate similar patient conditions by revealing insights into voiding inefficiency, the exact nature of the detrusor overactivity, and the severity of ongoing incontinence. Caregivers can order a battery of different tests, such as gauging abdominal or Valsalva leak point pressures, to distinguish voiding dysfunction from problems like bladder outlet obstruction or detrusor under-activity – raising the odds of choosing an appropriate treatment. For a deeper look at how urodynamics helps draw clearer lines between symptoms, check out our breakdown here.
These ideas shouldn't be too surprising. Even though it's impossible to deny the existence of a debate over urodynamics' role in pure SUI cases, the reality is that only around 5 to 10 percent of female patients suffer exclusively from SUI.
It's also worth noting that advances in modern urodynamics technology have made this form of testing less invasive, less discomforting, and increasingly accurate compared to previous versions. The ease of conducting on-site testing under the guidance of trained nursing staff should also incentivize more providers to turn to this alternative as opposed to relying so heavily on clinical histories and interviews.
Conclusions
Urodynamics testing isn't the only tool at caregivers' disposal for understanding and accurately diagnosing SUI cases. Because of its ability to assess a wide range of problematic symptoms, however, it deserves inclusion in treatment, especially when surgical intervention is under consideration.
About the Author
Brighter Health Network (BHN) provides urology practices, ObGyn practices, and Urogynecology practices with urodynamics nurse staffing and turn-key urodynamics testing. BHN lends is expertise in urodynamics to practices and hospital systems throughout the U.S. If you need help with urodynamics, please reach out to BHN.
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