If your bladder leaks when you sneeze, cough, laugh or exercise, you could be suffering from stress urinary incontinence (SUI), a condition caused by weakness in muscles in and around the pelvic floor. Although extremely common among women, SUI “accidents” can feel like more than an awkward inconvenience.
Stress urinary incontinence occurs when movement or activity puts physical pressure on your abdomen. It is different from urge incontinence or overactive bladder, which might have you regularly rushing to find a restroom. But the two can be related. According to Kevin Cwach, MD, a urologist with The Iowa Clinic, women with incontinence typically have a component of both types.
“Some women also have what we call insensate incontinence,” Dr. Cwach says. “They leak and they don't really know why or when. So, it’s important meet with a urologist and get that evaluated. It may require more specialized testing, or if you have mixed [urge and stress] incontinence, you might need more than one kind of intervention.”
Talking with your doctor can help you move from feeling shame or frustration around symptoms to finding solutions and staying dry.
Is stress urinary incontinence serious?
“Incontinence, in general, is rarely dangerous to your health,” Dr. Cwach says. “But it's all about how it impacts quality of life, overall.”
Stress urinary incontinence might start with an occasional trickle or have you soaking through multiple pads or disposable underwear products each day. It might also cause you to stay away from working out or engaging in activities that bring you joy but that you fear could trigger leaks.
Dr. Cwach encourages patients who are feeling discouraged by SUI symptoms to explore treatment options. He’ll start by identifying whether urge or stress is the primary form of incontinence and recommend the right method to get it under control.
“I see a lot of women that downplay or don't feel that the issue is big enough or bothersome enough to be treated,” Dr. Cwach says. “But you do have options, and these are often relatively simple solutions that you come in for and go home the same day.”
Who is most often impacted by stress urinary incontinence?
SUI is significantly more prevalent in women than men and according to Urology Care Foundation, about one in three women suffer from SUI at some point in their lives.
Pregnancy, which causes the pelvic floor to stretch and weaken, and whether you have had a vaginal childbirth, which can cause muscle damage in the pelvic area, increase the risk.
Other factors can include a history of radiation, or back or pelvic surgeries which can also impact the nerves of the bladder. Smoking can also contribute to SUI—partially because of the chronic cough associated with a longtime habit.
Connective tissue disorders such as Ehlers-Danlos syndrome are genetic influences that can cause stress urinary incontinence.
Muscle loss associated with advanced age Is a common factor, too. (About half of women aged 65 and older say they sometimes leak urine.)
What are some common treatments for stress urinary incontinence?
Several nonsurgical therapies can help treat stress urinary incontinence.
Dr. Cwach says he often starts by recommending pelvic floor exercises, known as Kegel exercises, for patients experiencing SUI. These exercises, which involve active contractions to strengthen the pelvic floor muscles, can be done at home and help control the flow of urine.
“For patients who need or want a little more guidance, we often refer them to pelvic floor physical therapists who can make sure that you are engaging the correct muscles and doing the exercises properly,” Dr. Cwach says.
If those exercises alone don't improve symptoms, he says another common nonsurgical option would be to fit a patient for a vaginal pessary. This soft, removable device supports areas that are affected by pressing against the wall of the vagina and the urethra.
“If these therapies fail to resolve the incontinence, then we talk about either a surgery or procedure,” Dr. Cwach says. “The gold standard now is something called a mid-urethral sling. This is involves making a small vaginal incision and putting in a piece of a synthetic mesh that essentially acts as a hammock to help support the urethra or the bladder outlet and pelvic floor to keep women from leaking.”
The outpatient procedure occurs under anesthesia and takes less than an hour. Dr. Cwach says the intervention can have a drastic positive impact on a patient’s quality of life. He recalls a patient with SUI who after a 45-minute procedure went from wearing four pads a day to being dry.
Misconceptions about mesh require patient education.
Common concerns Dr. Cwach hears from patients who might be candidates for a surgical solution surround the safety of vaginal mesh. Some women are wary of the procedure because they’ve seen media related to patient complications from vaginal mesh products. However, Dr. Cwach says the mesh used in the SUI procedure is a distinctly different and much safer product than the now banned type formerly used in prolapse repair.
“For women that might be concerned about having a synthetic piece of mesh or seeing the 1-2 percent chance of complications, there are other options as well,” Dr. Cwach says. “We can use some of their own tissue or what's called fascia as a natural support to help provide that hammock around the urethra.”
This method has a slightly longer recovery period but can be performed safely as a long-term, durable option for the appropriate surgical candidate.
The other class of interventions for stress incontinence include urethral bulking agents, which involve an injection into the urethra. This procedure is designed to support and plump the tissue of that outlet so that it does not allow leakage.
“If you imagine someone getting lip fillers and how their lips plump up and are more puckered—that’s what [bulking agents] do for the urethra,” Dr. Cwach says. “This is a great option in that you have immediate results, it’s well tolerated without anesthesia, and can sometimes even be done in the office. The downside of it is that it does not tend to last as long the sling procedure, meaning that patients may need repeat treatments every few years to maintain results.”
For this reason, it’s generally not recommended for younger and healthier patients as a long-term SUI management solution. But it can be a great option to offer relief and enhance the quality of life for people who don’t qualify as surgical candidates.
Taking the next steps to stop SUI.
If SUI-related “accidents” are causing you to change your regular activities, or making you uncomfortable, it’s important to bring up the topic with your provider.
Before your appointment, it can help to track your fluid intake, how often you urinate, and the triggers for leaks (i.e. running, getting out of the car, coughing, etc.) for a week or so. This journal can help guide the conversation and pinpoint problems.
The sooner you address stress urinary incontinence, the sooner you can start to enjoy a leak-free life. Schedule an appointment today.