Stress urinary incontinence (SUI) describes urine leakage that can occur with increased abdominal pressure, such as during coughing, laughing, sneezing, physical exercise or sexual activity.
SUI is a very common problem for women and affects nearly one half of the female population.
Causes and Risk Factors
Various factors can predispose or worsen SUI including:
- Increased age and reduction in estrogen with menopause
- Pregnancy and childbirth
- Prior pelvic surgery
When to Speak with a Urologist about Stress Incontinence
You should talk to a Urologist about Stress Urinary Incontinence if you have bothersome urine leakage with activities such as coughing, laughing, sneezing, or physical activity.
What to Expect when Seeking Treatment
In addition to a history and physical examination, initial assessment fortunately does not require invasive testing in straightforward patients. Important initial tests include urinalysis to rule out blood in the urine or infections, post-void residual evaluation to check for incomplete bladder emptying, and objective demonstration of leakage with a comfortably full bladder. Complex patients with additional urinary urgency, abnormalities on initial testing, prior surgery, or other conditions such as possible neurological disorders or pelvic organ prolapse may require further evaluation. Your doctor may order urodynamic testing to measure how the bladder stores and releases urine as well as cystoscopy to examine the bladder and urethral anatomy with a small telescope.
You will have lots of options ranging from conservative to more invasive treatments. You should proceed with treatments as necessary based on how much your symptoms bother you.
Observation without further treatment is reasonable if you are not bothered.
Behavioral and lifestyle modifications can improve SUI. These modifications include weight loss, fluid intake management, decreasing bladder irritants such as caffeine and alcohol, and smoking cessation. Further conservative treatment includes pelvic floor physical therapy (Kegel exercises) with biofeedback to strengthen the muscles in the pelvis.
Other non-surgical options can include the use of devices such as a vaginal pessary inserted into the vagina to correct pelvic floor prolapse. There is no current approved oral medication for SUI.
Surgical procedures span the use of injectable urethral bulking agents, autologous fascia pubovaginal sling using the patient’s own fascial tissue harvested from the abdominal wall, or a synthetic mesh mid-urethral sling. It is important to recognize that any procedure for SUI may not entirely eliminate urine leakage and that new bothersome urinary symptoms may occur including urgency or the inability to empty the bladder. Follow-up procedures may be necessary. Other risks, although uncommon, can involve damage to surrounding structures and persistent pelvic pain or pain with sexual activity. Sling procedures offer around 85% success rate at one year.
A mid-urethral sling with a permanent synthetic mesh is the most common and most extensively studied surgical approach. A specific risk of this procedure due to the placement of mesh through the vagina includes the possibility of mesh exposure or erosion that may require treatment with local hormone cream or subsequent procedures. Mesh erosion occurs in about 2% of cases at one year. Women with a history of diabetes or smoking are at greater risk for mesh erosion.