Stress Urinary Incontinence

Stress urinary incontinence occurs when urine leaks out with sudden pressure on the bladder and urethra, causing the sphincter muscles to open briefly. Mild SUI may develop due to pressure from sudden forceful activities, such as coughing, sneezing, and laughing. If your SUI is very severe then you may leak with less forceful activities like standing up, walking, or bending forward.

Stress urinary incontinence is a more common bladder problem for women than men.

Another common bladder problem is known as overactive bladder (OAB). People suffering from OAB have an urgency that they cannot control and they may leak. The difference between SUI and OAB is anatomical. SUI is a urethral problem and OAB is a bladder problem. With SUI, the sudden increase in pressure cannot be stopped by the urethra. With OAB, the bladder spasms and squeezes uncontrollably.

The symptoms of SUI, is when urine leaks out during any activity that puts mild to moderate pressure on the abdomen such as:

• coughing,
• sneezing,
• laughing,
• bending,
• heavy lifting,
• exercising, standing, or bending.

• The pelvic floor muscles support the bladder and urethra. If this gets stretched, weakened, or damaged, then SUI can happen.
• Pregnancy and childbirth can cause SUI.
• Chronic coughing or nerve injuries to the lower back or pelvic surgery can also weaken the muscles.

Stress urinary incontinence affects mostly older women but not everyone. It happens in younger women too due to childbirth and will come back to normal after some time.

Factors of SUI include:

• Obesity,
• smoking,
• chronic coughing,
• nerve injuries,
• prostate or pelvic surgery

A doctor may perform the following tests to understand why UTI is recurring:

• The doctor may look through your medical history which includes your previous and current health, frequency and severity of the symptoms, pain or other problems like bloating or constipation, diet, your menopausal status and childbirth history, any previous surgeries, and any ongoing medications.
• Physical exam may include checking your abdomen, the organs in the pelvis, and your rectum.
• Maintain a bladder diary- this will help the doctor to diagnose the problem and provide treatment to you.
• Pad test

Other specialized tests to diagnose are:

• A urinalysis
• Bladder scan
• Cystoscopy
• Urodynamic studies are done to test how your bladder, sphincter, and urethra hold and release urine.

Once the doctor diagnosis the type of incontinence you have, he/she will start the treatment that can make you feel better.

The doctor will explain the different treatment options to treat your SUI symptoms. He/ she will explain the benefits and risks of each option which will help you to decide what works best for your condition. You should know that not every treatment will work for everyone. You might need to try more than one to get relief from the symptoms.

Treatment options:

Lifestyle changes- absorbent pads, Kegel exercises, maintain good bowel function by eating fiber-rich foods, drink 6-8 glasses of water every day, maintain a healthy weight, bladder training, avoid smoking and alcohol.

Medical devices to manage SUI- if your pelvic floor muscles are weak then an inserted vaginal device may help prevent leaks. There are different types of devices which include- vaginal pessaries, disposable pessaries, non-disposable pessaries.

Urethral plug- to prevent SUI during high activity, these devices block the urethra while a vaginal device gives support through the vagina (these are used very rarely and in specific cases). Using these devices may irritate the vaginal tissue.

• Urethral injections,
• Sling surgery
• Midurethral sling
• Autologous sling
• Bladder neck suspension