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In the gynecological clinic, when I do a specialist examination for the patients, I will find that some people have vaginal relaxation, and  when she coughs forcefully downward, there will be a small amount of urine flowing out. Ask her: Do you usually have urine leak when you laugh or sneeze? Most likely will get a positive answer. Then she would ask me: Is this a case of illness? What is the cause? Can it be treated? How to treat it?

Let me briefly introduce you to stress urinary incontinence.

Stress urinary incontinence is an involuntary leakage of urine when the  abdominal pressure suddenly increases. It belongs to pelvic floor dysfunction disease. The main pathogenesis is: at the bottom of the pelvis, the muscles and ligaments around the urethra, vagina and rectum are relaxed and damaged; elasticity and tension are reduced, and their supporting force to pelvic organs is decreased. When abdominal pressure suddenly increases (e.g. sneezing, laughing or coughing), bladder and urethra move downward, urethra loses the closing effect of pelvic floor muscle contraction, and urine will flow out involuntarily.

This often happens for women who have had vaginal delivery and middle-aged and elderly women. Occasional symptoms have not been paid attention to and some patients with severe symptoms are also difficult to tell the doctor about their condition until it affects their daily life. In fact, for diseases, early diagnosis and treatment can achieve good results and cost less.

What is the etiology of stress urinary incontinence?
The most common cause is birth injury. Vaginal delivery, fetal macrosomia and forceps may cause pelvic floor muscle, fascia and ligament damage. Lack of pelvic floor muscle repair training after birth, and holding the baby and lifting heavy objects aggravate pelvic floor muscle and fascia relaxation.
The second common cause is aging. With the increase of age, and perimenopause and postmenopause, the decrease of estrogen level in vivo will lead to the loss of nutritional function of pelvic floor muscles, which will also lead to pelvic floor muscle relaxation. This kind of people often have uterine prolapse, bladder prolapse and rectal prolapse.
The third cause is chronic cough, asthma, constipation, obesity and other causes of chronic abdominal hypertension will be complicated with stress urinary incontinence.
There is also inappropriate physical exercise, training the rectus abdominis, pelvic floor muscle relaxation.

If you suspect that you may suffer from stress urinary incontinence, you should see a doctor in time. Doctors can differentiate the type of urinary incontinence and judge the degree of pathological changes by inquiring about medical history and special examinations. Urgent urinary incontinence differs from stress urinary incontinence in that one is anxious to go to the toilet whenever he wants to urinate, otherwise he will not be able to control his urine. This kind of urinary incontinence has nothing to do with the increase of abdominal pressure. Urodynamic tests and pelvic floor muscle measurements are also needed to confirm the diagnosis. Then distinguish the severity of urinary incontinence. Simply put, the leakage of urine during sneezing is mild; the leakage of urine during walking is moderate; and the change of body position, such as the leakage of urine when standing, belongs to severe stress urinary incontinence.

Depending on the extent of the lesion, the doctor will give a treatment plan.
Generally, mild and moderate stress urinary incontinence does not require surgery. Regular contraction and relaxation of the anus exercise, also known as Kegel training, can achieve the effect of controlling urinary incontinence and improving symptoms.
At the same time, for perimenopausal and postmenopausal women, appropriate estrogen supplementation can also increase the thickness and elasticity of vaginal mucosa, delay muscle aging and degeneration; timely treatment of chronic cough and asthma of respiratory tract, keep defecation unobstructed, less abdominal pressure overexertion, can control and prevent the aggravation of urinary incontinence from the etiological aspects.
Another non-invasive and painless method of pelvic floor muscle treatment is biofeedback electrical stimulation training. The patient is lying on the bed. The doctor puts the probe which produces electrical stimulation into the vagina and controls the contraction and relaxation of pelvic floor myoma by computer program, so as to achieve the purpose of treatment. Surgery is an effective treatment for moderate to severe patients.
The surgeon will design the operation plan according to the specific condition of each patient before operation, and fully discuss and communicate with the patient in order to achieve the best operation effect.

Stress urinary incontinence is a common disease among middle-aged and old women, which affects their healthy life. The sick people need to have a certain understanding of it, for early prevention and treatment, so that their everyday life is healthy and comfortable.

Zhao Yan, Professor of Obstetrics and Gynecology

Professor, Chief Physician, Department of Obstetrics and Gynecology, Peking University People's Hospita

Since graduating from Beijing Medical College in 1982, Dr.Zhao has been engaged in clinical medicine, teaching and doing scientific research in the Department of Obstetrics and Gynecology, Peking University People's Hospital.

Dr. Zhao is  very experienced at diagnosis and treatment of gynecological diseases, inflammation, tumors, abnormal uterine bleeding, pelvic floor dysfunction diseases, endocrine disorders, etc. She has also rich clinical experience and surgical skills.