Malfunction of the sphincters is the main cause of stress incontinence. As a result of the pelvic floor relaxation, this muscle layer is situated higher and the sphincters get outside the abdominal cavity. With minor contractions of the abdominal cavity (coughing, exercise, and laughing) small amounts of urine are lost, because the sphincters cannot resist the pressure. Stress incontinence has high incidence in post-partum,
post-menopausal and elderly women. Side effects of certain drugs can cause sphincter malfunction.
α-adrenergic blockers e.g. reduce sphincter contraction. Treatment of stress incontinence starts with behavioural therapies and pelvic muscle exercises (Kegel). Pharmacological treatment is aimed at stimulation of the sphincter contraction, but is not very effective. In some serious cases, surgery can be useful.
The first-line therapy for stress incontinence includes:
Extra info: Any of these agents can be used as first-line therapy; however, the clinical response to them tends to be limited. Therefore, surgery often is the ultimate therapy.