Learn About Stress Urinary Incontinence (SUI)

Stress urinary incontinence (SUI) is the most common form of urinary incontinence and affects up to 48% of women over 18 years of age.1 It occurs when the bladder leaks urine during physical activity or exertion like coughing, running or lifting something heavy. Women experience SUI when the muscles that support the bladder, like the pelvic floor and sphincter, weaken, making them more vulnerable to unintentional leakage.2 There are different types of urinary incontinence. Women may also experience urge incontinence or overactive bladder (OAB), which is marked by a strong need to urinate that cannot be controlled.1 And in many cases, women will experience both OAB and SUI at the same time, known as “mixed incontinence.”2 SUI differs from OAB by affecting the urethra, rather than just the bladder. OAB strictly affects the bladder organ, while SUI occurs when the pelvic floor/urethra muscles are not strong enough to hold the urine in, so any additional pressure on the pelvis could cause a leak. There a several causes and risk factors that make women more likely to experience SUI:

While pregnancy and childbirth are a leading cause of SUI, it’s a common condition that affects many women at different stages of life. Childbirth is a leading contributor as it can cause the pelvic floor muscles to weaken due to pressure and possible nerve damage during delivery. Women may seek treatment for SUI between pregnancies, but additional pregnancies can cause repeat incidences of SUI.

Pelvic surgeries like hysterectomy and nerve injuries to the lower back can also weaken the same pelvic floor muscles, leading to SUI.2

Risk Factors 4

  • Age - the likelihood of experiencing any type of urinary incontinence, whether SUI or OAB, tends to increase with age.
  • Being Overweight - excess weight increases pressure on the abdominal and pelvic organs.
  • Smoking- smoking can lead to chronic cough that results in pressure to the bladder.

The primary symptom of stress urinary incontinence (SUI) is bladder leakage, but what distinguishes SUI from Overactive Bladder (OAB) is the activity that precedes the leak. If a woman is experiencing SUI, she will leak urine during high-impact activities that put forceful pressure on the bladder and urethra.  These activities include:  

  • Coughing
  • Laughing
  • Sneezing
  • Standing up or getting out of a car
  • Heavy Lifting
  • Physical Activity
  • Having sex

When a person has mild SUI, leaking occurs during these more forceful activities, while moderate to severe instances of SUI can trigger leaks during much less strenuous activities, like standing up or bending over.4

It is common for women with SUI to have mixed incontinence, which means they also experience symptoms of overactive bladder (OAB). For these women, leakage is also associated with an urgency to urinate that often leads to accidents.2

Stress Urinary Incontinence (SUI) Treatment Options

SUI is often associated with shame and embarrassment, which could delay women from seeking medical treatment – or at the least from recognizing that it is a true medical condition, and not just an embarrassing biproduct of childbirth or aging.

There are a number of treatment options available to women, depending upon their medical history or preferences. Women experiencing mixed incontinence (symptoms of SUI and OAB) should consult a doctor about which symptoms are most bothersome, and as a result, which treatment option would be most effective.  For a full list of OAB treatment options, click here.

Lifestyle has a tremendous impact on pelvic health, and making simple changes can make a difference in the management of SUI. This starts with liquid consumption.  Women should ask their doctor how much liquid they should be drinking to reduce trips to the bathroom, without sacrificing hydration. To help with this, drinks with caffeine or alcohol should be avoided, especially before bedtime.

Maintaining a healthy weight plays a significant role in bladder control as an increase in BMI can contribute to bladder leakage.  Because physical activity can be troublesome for women with SUI, ask your doctor about weight control strategies and exercises that don’t require jumping or running that may exacerbate SUI.

Lastly, here’s one more reason to quit smoking.  Smoking raises your chances of developing stress incontinence as it often causes chronic cough. So put down the cigarettes for good - not only for your bladder health, but your overall health. 

Exercises

Doctors will often recommend therapies or exercises designed to help strengthen the pelvic floor muscles to prevent unintentional leakage.

Kegel exercises do just that. To perform Kegel exercises, contract the muscles that you would normally use to stop the flow of urine, hold the contraction for three seconds, then relax for three seconds. Repeat this pattern 10 times. As your muscles strengthen, hold the contraction longer, gradually working your way up to three sets of 10 contractions every day. Kegel exercises can be done anywhere – sitting or lying down or standing up.

Your doctor may also recommend an exercise that trains your body to suppress the urge to urinate by delaying urination when the urge arises; starting with 30-minute and slowly working your way up to urinate every three to four hours.  The same training can also be achieved through scheduled bathroom trips to get yourself on a schedule rather than waiting until you feel the urge.   

While there are no approved drugs in the U.S. for SUI, there are devices designed to help women manage their symptoms.

Pessaries: Pessaries are insertable devices that are shaped like a ring and sit on both sides of the urethra. This device provides support to the bladder to help prevent leaks. Pessaries are inserted by a doctor and require routine removal and cleaning.

Urethral inserts: These inserts are disposable and can be used for specific activities that may cause leakage. Urethral inserts are typically used when a person knows they will be performing an activity that causes leakage as they can be worn throughout the day and removed later on.

Surgical interventions for SUI are used to improve closure of the sphincter and support the bladder. Surgery to treat SUI is not recommended for women who plan to become pregnant again, as pregnancy and delivery can lead to future instances of SUI. Before exploring surgery, women should discuss their treatment options with their doctor to identify the best option for them.

Bulking Agents: Bulking agents are injectable gels used to thicken the tissue around the urethra and bladder. The thickened tissue benefits the sphincter’s closing ability, ultimately preventing leakage. Bulking agents are noninvasive, and require multiple injections.

Sling Procedures: Sling procedures are the most common procedure for women experiencing SUI. During a sling procedure, surgeons can use either a woman’s own tissue, synthetic material or potentially additional donor tissue to create an internal sling that’s used to support the urethra. The sling sits under the urethra and holds the bladder in place.

Retropubic Colposuspension: Colposuspension (sometimes referred to as a Burch) is performed either laparoscopically or via abdominal incision. The procedure works by attaching sutures to abdominal ligaments or bones to help lift and support the tissue surrounding the bladder and urethra. This procedure typically requires more recovery time than sling procedures.

REFERENCES

  1. The Prevalence of Urinary Incontinence, Victor W. Nitti, MD, Reviews in Urology, June 2001. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476070/.
  2. Mayo Clinic. Stress Incontinence. Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/stress-incontinence/symptoms-causes/syc-20355727. Accessed March 27, 2019.
  3. Urinary Incontinence. Office on Women’s Health. https://www.womenshealth.gov/a-z-topics/urinary-incontinence. Accessed March 27, 2019.
  4. Urology Care Foundation. The Official Foundation of the American Urological Association. https://www.urologyhealth.org/urologic-conditions/stress-urinary-incontinence-(sui). Accessed March 27, 2019.
  5. Mayo Clinic. Stress Incontinence. Diagnosis & Treatment. https://www.mayoclinic.org/diseases-conditions/stress-incontinence/diagnosis-treatment/drc-20355732. Accessed March 27, 2019.
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