Stress Urinary Incontinence
Bowel/Bladder, Urology

Stress Urinary Incontinence

Posted March 22, 2024

What is Urinary Incontinence?

Urinary incontinence occurs when you experience accidental urine leakage. Many women suffer from some type of urinary incontinence. There are four major types of incontinence:

  • Stress Urinary Incontinence:  The unintentional leakage during exertion, activity or movements, such as coughing, sneezing, laughing and exercising. This is also known as stress incontinence.
  • Urge Incontinence: The sudden intense urge to urinate followed by urine leakage. You may feel like you can never get to the bathroom fast enough or wake several times through a night with a strong urge to urinate.
  • Mixed Incontinence: Occurs when women have both stress and urge incontinence.
  • Overflow incontinence: Occurs when the bladder doesn’t completely empty. It may be caused by dysfunctional nerves or a blockage in the urethra.

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Stress Urinary Incontinence

Stress Urinary Incontinence (SUI) is the most common type of incontinence and can be the cause of some very embarrassing situations. There are treatment options available that could reduce urine leakage or stop it all together. SUI occurs when urine involuntarily leaks during exertion, activity or movements. This can be caused by the weakening of the pelvic muscles that support the bladder and urethra.

Urology

Common Symptoms

You may have SUI if you leak urine when you:

  • Cough, laugh or sneeze
  • Exercise, life or walk
  • Engage in intercourse
  • Get up from a seated or lying position

Many women will make changes to their lifestyle to avoid embarrassment from accidental urine leakage. Do you:

  • Wear a sanitary pad to absorb urine?
  • Avoid or limit some activities to prevent accidents?
  • Limit the amount of fluids you drink to avoid accidents?
  • Go to the bathroom frequently to avoid accidents?
  • When planning an outing or trip does the availability of restroom facilities affect your decision?

If you have answered yes to any of the above, take the next step and talk with your health care provider about treatment options.

Common Causes

One of the myths of SUI is that it is a natural party of aging. It can affect women at any age. Although common, SUI is not a normal part of aging. Weakening of the muscles and supporting ligaments within the pelvis can occur because of:

  • Pregnancy and childbirth
  • Connective tissue disorders
  • Chronic heavy lifting or straining
  • Menopause
  • Obesity
  • Smoking
  • Coexisting conditions such as pelvic organ prolapse

Diagnosis

SUI may be diagnosed based on the symptoms you describe to your health care provider and after a pelvic exam focused on your pelvic support. Your health care provider may ask you to cough with a full bladder to observe leakage. Some health care providers will conduct special bladder function tests (urodynamics) to evaluate your bladder and urethral function. These tests usually involve placing a small tube, called a catheter into the bladder which can measure the bladder and urethral activity. Urodynamics may be useful in helping your health care provider determine exactly what type of incontinence you have and make recommendations for treatment.

Treatment Options

SUI is treatable at any age, but not all approaches work for every person. Your health care provider may suggest one or more of the following:

  • Behavioral/Muscle Therapy: Therapy starts with Kegel exercises to help strengthen the pelvic floor muscles.
  • Biofeedback: While exercising the pelvic floor muscles you are connected to an electrical sensing device the provides “feedback” Over time, biofeedback can help improve muscle control to prevent urine leakage.
  • Electrical Stimulation: This approach sends a mild electric current to the pelvic muscles or nerves that are involved in urination.
  • Medication: Currently, there are no medications approved to treat SUI. However, other types of urinary incontinence, like urge incontinence can be treated with medications.
  • Bulking Agents: An injectable therapy that can be used to thicken the wall of the urethra to help control urinary flow.
  • Minimally Invasive Surgical Sling Procedure: This is an outpatient procedure in which a thin piece of flexible, permanent surgical mesh is placed under the urethra, like a sling to prevent involuntary urine leakage. In some patients, an impatient procedure may be required.

Minimally Invasive Surgical Sling Procedure

To find out if the minimally invasive surgical sling procedure is right for you, talk with your health care provider that is trained to perform the procedure. The procedure should not be performed on women who are pregnant or are planning future pregnancies. Women who smoke have a higher risk of mesh exposure and should consider smoking cessation before undergoing this surgery.

The Procedure

The procedure typically takes 30-minutes; in some patients, an inpatient procedure may be required. The procedure is performed under a local, regional or general anesthesia. The mesh is inserted through small incision in the vagina, and exits through two small incisions in the lower abdomen or inner thigh.

After the Procedure

Most patients will return home the same day as the procedure and are able to resume most daily activities. Most will see immediate results following the procedure with significantly less or no leakage. You may have minimal scarring and should not feel the mesh once it has been placed. Your health care provider may advise you to rest for 24-48 hours, avoid heavy lifting and sexual intercourse for four to six weeks.

There are risks associated with all surgeries, be sure to ask your health care provider about the risks associated with this procedure.

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