Incontinence & Overactive Bladder Health Center

Related to Incontinence & Overactive Bladder (OAB)

Stress Urinary Incontinence (SUI)

Treatments for Incontinence & Overactive Bladder (OAB)

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Stress urinary incontinence (SUI) - accidental leaks when you cough, laugh or sneeze - is the most common form of urinary incontinence in women.

SUI happens when your sphincter, which acts like a valve to the bladder, can’t stay closed when there’s pressure in your abdomen. As a result, the sphincter opens slightly and allows a small amount of urine to leak out.

SUI is caused by stretched pelvic floor muscles as from childbirth or weight gain. When these muscles no longer support your bladder properly, the bladder drops downward and pushes against the vagina, preventing tightening of the muscles that ordinarily close off the urethra.

SUI causes urine to leak when you:

•    Cough, laugh or sneeze
  

•    Exercise (particularly jumping)
  

•    Lift or do any movement that puts pressure on the bladder, i.e. bending
  

•    Have sex (particularly upon penetration
  

In severe cases even walking or getting up out of bed or a chair can cause leaks.

You may also find that SUI is worse during the week before your period. This is because hormones released by your body during that week have an effect on the muscles of your pelvic floor, which support the bladder and urethra.

SUI can worsen with the drop in estrogen that comes after menopause.

Who gets SUI?

It's estimated around one in three women get SUI at some point in their lives. It can happen at any age, although it's more common in women between the ages of 35 and 60.

Stress urinary incontinence is rare in men,

and is usually a result of injury or prostate surgery.

What causes SUI?

SUI is due to weakness in the sphincter muscle and the pelvic floor muscles that support the organs in your pelvis and abdomen.

Things that can weaken the pelvic floor:

• Pregnancy - carrying the increasing weight of baby in your pelvis over 40 weeks puts extra stress on your pelvic floor. Also, during pregnancy the hormone relaxin softens the muscles of the pelvic floor ready for the birth. Research has indicated that approximately 50% of pregnant women suffer from SUI.
  

• Childbirth - if your baby is born vaginally, it’s possible the nerves around your pelvic floor become stretched and bruised. After delivery, the nerves can’t make the pelvic floor work properly and the muscles may not respond as well.
  

• Being overweight - extra weight puts more pressure on your abdomen, which in turn puts more pressure on your pelvic floor. Studies have shown that men and women who were overweight were nearly twice as likely to have SUI as someone of normal weight.
  

• Hysterectomy - a hysterectomy is an operation to remove the womb (uterus). The surgery can cause damage to the pelvic floor.
  

• Smoking - having a chronic cough puts pressure on the pelvic floor and makes SUI worse.
  

• Menopause - after the menopause your estrogen levels are lower, which can mean muscle pressure around your urethra is weaker and leaks are more likely. Your urethra may be less elastic and less able to close completely.
  

• Certain medications can affect the pelvic floor. Examples are blood pressure medication, some antidepressants and sedatives, and some muscle-relaxant drugs.
  

Things that can damage the sphincter muscle:

• A pelvic fracture
  

• Bladder neck surgery
  

• Radical prostatectomy (for men)
  

How can SUI be treated?

Stress urinary incontinence is generally managed by non-invasive therapies such as:

• Lifestyle changes to reduce pressure on your bladder i.e. stopping smoking, watching/losing weight and a bladder-friendly diet.
  

• Pelvic floor exercises - with or without vaginal cones biofeedback
  

If noninvasive treatments and/pr medication doesn't help your SUI, your doctor may suggest a surgical approach such as:

• Bladder neck suspension or sling
  

• Collagen injections around the urethra
  

• Implantation of an artificial urinary sphincter or sacral nerve stimulator
  

• Tension-free vaginal tape (TVT).
  

If you answer "Yes" to one or more questions below,

you may have stress incontinence.

Do you sometimes leak urine during exercise or lifting?

Do you sometimes leak urine when you cough, laugh, or sneeze?

Do you usually leak a small to moderate amount of urine?