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Women: Speak Up About Stress Urinary Incontinence

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It’s a common condition, and help is available

Posted by Joshua Cohn, MD, FPMRS

You may not be familiar with the term stress urinary incontinence, or SUI. But there's a good chance that you or a woman you know is affected by the condition. One in three adult women experiences symptoms of SUI at some point in their lives, making it the most common type of female incontinence. 

Stress urinary incontinence is a condition characterized by a sudden leakage of urine caused by an increase in belly pressure (such as a cough, sneeze, or bending to lift a heavy item). As a urologist who specializes in treating female bladder conditions, I know firsthand how SUI can affect women's lives. Worrying that you might lose control of your bladder can cause stress or anxiety, and experiencing a leak can feel embarrassing. These feelings can get in the way of work and social activities and may even affect a woman's sex life. 

Many women avoid talking about SUI with their doctors because they're uncomfortable. Some may even think that talking about it is pointless because the problem can't be fixed. But, for me, asking and talking about urine leakage with my patients is something I do all the time. What's more, I can offer women a number of treatment options to manage their SUI and help them regain a sense of control over their bladders. 

What are the risk factors for stress urinary incontinence?

SUI happens when the muscles that prevent the unwanted release of urine by supporting the urethra — the tube through which urine leaves the body — become weak. When these valve-like muscles are strong, they stay closed even as the bladder expands with urine. This holds urine in until you're ready to use the bathroom. But the muscles open more quickly once they weaken. So what causes these muscles to lose their strength? Common factors include

Childbirth. Giving birth can damage the pelvic floor muscles or urethral sphincter, especially during vaginal deliveries or rapid deliveries involving forceps. SUI can develop shortly after delivery or many years later. In some cases, SUI caused by childbirth will improve over time. 

Age. Older women are more prone to SUI (regardless of whether they have had children). The simple act of aging causes the bladder muscles to weaken, which can lead to incontinence.

Excess body weight. Extra weight puts more pressure on the organs in the abdomen and pelvis. This can weaken the surrounding muscles and increase the risk for SUI.  

Previous pelvic surgery. Surgeries such as hysterectomy can contribute to muscle weakening or nerve damage that could cause SUI. 

Chronic coughing. This can be caused by smoking or an illness. In either case, frequent coughing subjects the pelvic muscles to more wear and tear.

High-impact activities. Increased pressure, over time, can also occur from running or jumping. 
Once the muscles that support the urethra weaken, any activity that puts pressure on them can cause urine to leak, such as:

  • Coughing 
  • Sneezing
  • Laughing
  • Bending over
  • Lifting a heavy object
  • Exercising
  • Having sex
  • Standing up or walking 

It's worth noting that SUI isn't the same as urge incontinence or overactive bladder. (Though it's possible to have both, and many women do.) Urge incontinence causes a person to experience an urgent, uncontrollable need to urinate, which can result in leakage if they can't get to the bathroom in time. 

Treating stress urinary incontinence

I have a number of tools for managing SUI that I recommend. Different treatments work best for different people, and figuring out the ideal option calls for an in-depth conversation about a patient's symptoms, age, preferences, and lifestyle habits. 

Possible lifestyle changes

Bladder training. This involves urinating on a fixed schedule to gradually lengthen the amount of time between bathroom trips. It's best done under the guidance of a physician and physician therapist since the tactic could make leaks worse in some cases. 

Getting to a healthy weight. Losing as little as 10-15 pounds, in women who are carrying extra weight, can help reduce leaking by half or more.  

Maintaining healthy bowel function. Constipation can put more strain on already-weakened pelvic floor muscles. Eating a fiber-rich diet, drinking plenty of water, and being active every day often can help ease constipation. 

Quitting smoking. I tell my patients who smoke that quitting can make a significant difference in their SUI symptoms. Quitting reduces chronic coughing, putting less strain on pelvic muscles. 

Possible nonsurgical treatments

Pelvic floor therapy. A pelvic floor therapist can teach you how to properly perform exercises like Kegels, which improve the strength of pelvic floor muscles so they can retain urine longer. Kegels work best when done every day. 

Pessaries. A pessary is a removable vaginal insert that supports and repositions the urethra to reduce SUI. Disposable pessaries can be used for up to 8 hours at a time and are available over the counter. Nondisposable pessaries can be worn 24 hours a day (except during sex), but many of my patients remove them at night. Nondisposable options are made of medical-grade silicone and must be fitted for you by a specialist. Pessaries are generally safe, but they do pose a small risk of infection.

Urethral injections. Transurethral bulking agents can be injected into the urethra to thicken the space surrounding it to control leaks. The effects can diminish over time, but it's a good option for patients looking for a minimally invasive procedure. Temple Health is one of the few hospitals in the region offering bulking agents like Bulkamid

Possible surgical treatments

Not every woman with SUI needs surgery, but it can be highly successful in managing severe symptoms, especially when combined with lifestyle changes. Surgery isn't typically recommended for women who plan to become pregnant in the future; vaginal deliveries can cause SUI symptoms to come back, requiring additional surgeries. 

Sling surgery. The most common surgical option for SUI, sling surgery involves placing a small strip of material under the urethra. The sling acts like a hammock to support the urethra and keep it from moving downward during activities. There are a number of sling techniques available, and slings can be made of a patient's own tissue, donor tissue, or surgical mesh. There are pros and cons to different methods and materials, so it's important to discuss the options with your physician to make an informed decision. 

Bladder neck suspension or colposuspension. This procedure places stitches in the tissue near the neck of the bladder to provide extra support for the urethra and sphincter muscles. Bladder neck suspension comes with some risks — for example, there may be problems emptying the bladder after surgery and the stitches may need to be loosened — so again, discuss the benefits and drawbacks with your doctor.  

Get help for stress urinary incontinence

Stress urinary incontinence is a common condition that's highly treatable. If you're affected by stress leakage, get the help you need. Schedule an appointment with a Temple specialist who can work with you to find an effective way to manage your SUI.

Helpful Resources

Looking for more information?

Joshua Cohn, MD, FPMRS

Dr. Cohn is a urologist specializing in the medical, procedural, and surgical management of urinary symptoms in men and women including urinary leakage and difficulty urinating, female urethral disorders, pelvic organ prolapse, and bladder dysfunction caused by a neurologic condition, injury, or cancer treatment.

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