I laughed and urine leaked, causes and treatments of stress urinary incontinence

Causes of stress urinary incontinence

Urinary incontinence is the leakage of urine against your will. Urinary incontinence is a very common disease that affects about 40% of women in Korea, and it is said that middle-aged women after menopause are more likely to develop urinary incontinence due to the shorter length of the urethra than men and the experience of childbirth.

The most common type of urinary incontinence in middle-aged women is stress urinary incontinence. Stress urinary incontinence occurs when the pressure in the bladder rises above the pressure in the sphincter due to a sudden increase in abdominal pressure. In other words, when you sneeze, laugh, climb stairs, or other situations that put pressure on your stomach, you leak urine. The main cause is that the pelvic floor muscles or urethral sphincter weaken during delivery, causing the bladder and urethra to droop downward.

Treatment of stress urinary incontinence: first, Kegel exercises

Pelvic floor muscle exercises are one of the effective non-surgical treatment methods. Pelvic floor muscle exercises are exercises that strengthen the pelvic floor muscles, and you can easily think of Kegel exercises. It is said that urinary incontinence in the early stages can have a great effect with Kegel exercises alone.

Kegel exercises are performed by repeatedly squeezing and releasing the urethra. The International Society of Urinary Incontinence (ICS) recommends repeating this contraction exercise 3 times of 8~10 times for 6~8 seconds. It is recommended to do it 3~4 times a week for at least 15~20 weeks.

Remember well the feeling of stopping in the middle of urinating, and repeat the contraction and relaxation of the muscles (urethral muscle muscles) that sensation. You can start at low intensity and gradually increase to high intensity. Start by squeezing for 5 seconds and releasing for 5 seconds, and gradually increase the contraction and relaxation time as you get used to it. We recommend doing 10 sets of 3 repetitions a day.

It is not necessary to insist on lying down and raising your buttocks. It's easy to do it lying down at first, but you can do it anytime. We recommend that you dedicate 5 minutes a day to your daily routine and make it a habit.

Kegel exercises are an effective treatment for urinary incontinence as there are studies that show that 60~80% of patients who continued exercising for more than 3 months showed improvement in their symptoms. However, it is difficult for patients to understand the method and it is not easy to sustain it for a long time. It doesn't take into account the pelvic floor muscles of each patient, so it can be too much or insufficient.

Treatment for stress urinary incontinence: Second, tape surgery (TOT)

Stress urinary incontinence is generally difficult to cure spontaneously. This is because the genitals, such as the bladder, urethra, and uterus, are closely connected to the pelvic floor muscles, which worsen with age. Therefore, if you have stress urinary incontinence, you may want to consider surgery.

So, how do you decide if you want to have surgery for urinary incontinence? When you urinate, you can take a urodynamic test that measures abdominal pressure and intravesical pressure. Normally, with urinary incontinence, the urinary leakage pressure* is measured between 60-120 cmH2O. The lower it is, the less force it is, so you can understand that it is a condition that requires surgery.

*Urinary leakage pressure: VLPP, abdominal pressure when urine leaks by straining the stomach

Urinary incontinence surgery has been performed in the past by open surgery, but the relatively recent development of TOT is much simpler. All you need to do is place a little harmless biometric tape on the central urethra. This tape supports the urethra area under pressure due to sudden coughing or sneezing, preventing urine from coming out. It is less likely to damage nerves and blood vessels or irritate the bladder, and it is performed under local anesthesia, so there is less burden on anesthesia. The cure rate of urinary incontinence with tape surgery is very high, around 90%, and the surgery time is about 20~30 minutes, so that you can live your daily life from the day after surgery.

However, urinary incontinence surgery is only recommended for severe stress urinary incontinence. If you have urge incontinence, the main symptom is frequent urination or inability to hold urine, surgery may not help much.

In addition, tape surgery also has side effects. Since the surgery is performed with the legs fully open, the leg pain may last for a long time after surgery. Patients who have undergone vaginal surgery, patients with bladder disease, and obese patients have a 6% chance of bladder perforation. In addition, even after surgery, if you exercise intensely, urinary incontinence may recur.