Stress Urinary Incontinence (SUI)

Stress Urinary Incontinence (SUI) is when urine leaks out with sudden pressure on the bladder and urethra, causing the sphincter muscles to open briefly.  The pressure may be from sudden forceful activities, like exercise, sneezing, laughing or coughing. You may also leak with less forceful activities like standing up, walking or bending over. Leakage can range from a few drops of urine to enough to soak through your clothes. About 1 in 3 women suffer from SUI at some point in their lives. Urinary incontinence generally continues to worsen with age. Over half of women with SUI also have overactive bladder (OAB).

How Can SUI Affect My Life

Many people find that SUI gets in the way of daily and social activities. It can affect family and sexual relationships. Some people even begin to feel isolated and hopeless because of it.

You may be embarrassed about this problem. You may not want to talk about it with a loved one or even a doctor. Please know that we can help.

Ask yourself whether leaking urine or the fear of leaking urine has:

    • Stopped you from doing things outside of your home?
    • Caused you to be afraid to be too far from a bathroom or a change of clothes?
    • Stopped you from exercising or playing sports?
    • Changed the way you live because you’re afraid of leaks?
    • Made you uncomfortable with yourself and your body?
    • Changed your relationships with friends or family?
    • Made you avoid sex because you are worried that you will leak urine and be embarrassed?

If you answer yes to some of these questions, you should know that things can change for the better. There are many ways to manage and treat SUI.

What Increases My Risk Of Getting SUI

Risk factors for SUI include:
    • Gender: females are more likely to get SUI
    • Pregnancy and childbirth
    • Being overweight
    • Smoking
    • Chronic coughing
    • Nerve injuries to the lower back
    • Pelvic or prostate surgery
Possible testing for complete evaluation

These specialized tests may be used for your diagnosis:

    • A urinalysis or urine sample to test for a urinary tract infection or blood in the urine.
    • A bladder scan after urinating to show how much urine stays in your bladder after you urinate.
    • A Cystoscopy uses a narrow tube with a tiny camera to see into the bladder to rule out more serious problems.
    • Urodynamic studies (UDS)are done to test how well the bladder, sphincters and urethra hold and release urine.

Once we understand the type of incontinence you have and rules out other conditions, we will offer you treatment options to feel better.

Treatment

There are currently no drugs approved in the U.S. to treat SUI.

SUI treatment options:

What Lifestyle changes can treat SUI?

Absorbent Pads
You may need to rely on absorbent pads. Pads are also used when waiting to have surgery or during recovery from surgery. Absorbent pads come in different sizes and styles.

Pelvic Floor Muscle Exercises (also called Kegel exercises)
Kegel exercises help strengthen your pelvic floor muscles. You perform Kegels by contracting (squeezing) and relaxing the pelvic floor muscles many times each day. Pelvic floor muscles help support the bladder and other organs. Exercising these muscles can make them stronger and help reduce or eliminate your SUI symptoms. To get the most benefit, do these exercises every day.

To make sure you perform these exercises correctly, we will refer you to a physical therapist. This therapist is someone who specializes in strengthening pelvic muscles.

Maintain Good Bowel Function
Constipation can make incontinence worse. Try to prevent constipation. Eat high fiber foods (fruit, beans and dark-colored vegetables) to encourage regular bowel movements. It helps to drink 6 to 8 glasses of water each day, and exercise daily.

Maintaining a Healthy Weight
People who are overweight or obese are more likely to develop SUI. Losing weight reduces the severity of SUI. Many people find that losing just 10 pounds can help.

Quit Smoking
Quitting smoking is one of the most important things you can do for your health. A chronic cough from smoking may increase the frequency and severity of leaks. It may also cause added strain to the pelvic floor. When you quit smoking, coughing may decrease. This helps to reduce pressure on the pelvic floor muscles, which reduces incontinence.

Surgery for SUI in women is usually very successful. While each of the most commonly performed surgeries are similar in terms of success rates, they have different risks. It is important to understand your options so you can feel confident about the decision you make. 

Below are different surgical procedures specific to men and women for SUI.

Urethral injections are used to “bulk up” the urethral sphincter muscle that keeps the urethra closed. “Bulking agents” are injected into the urethra. This helps the sphincter to close the bladder better.

Often, the injections are done under local anesthesia in the office. The injections can be repeated if needed. This method may not be as effective as other surgeries, but the recovery time is short. Bulking agents are a temporary treatment for SUI. Of every 10 women who have these injections, between 1 in 3 are cured of incontinence, which can last for a year.

Sling Surgery

The most common surgery for SUI in women is “sling” surgery. In this surgery, a small strip of material (a sling) is placed under your urethra to prevent it from moving during activities. It acts as a hammock to support the urethra. Many sling techniques and materials have been developed. Slings can be made from your own tissue, donor tissue or surgical mesh.

These are the primary sling surgeries used to treat SUI:

  • Midurethral sling-The midurethral sling is the most common type of surgery used to correct SUI. The sling is made out of a narrow strip of synthetic mesh that is placed under the urethra.
    • For sling surgery made from surgical mesh, we only need to make a small cut (incision) in the vagina. The sling is then inserted under the urethra and anchored in the surrounding pelvic floor tissue. This surgery is short and recovery may be shorter than with an autologous sling. There are additional risks associated with using mesh that you should discuss with your surgeon.
  • Autologous sling-In this type of surgery, the sling is made from a strip of your own tissue (autologous) taken from the lower abdomen. The ends of the sling are stitched in place through an incision in the abdomen. To use your own body tissue for a sling, an additional incision is made in the lower belly to collect tissue that will used for the sling. Autologous sling surgery is usually done through a cut in the bikini line. The surgery is most often done in less than 2 hours. This surgery does require more time to recover than a mid-urethral sling surgery. There are additional risks associated with this type of surgery. 

Surgery for Men with SUI


Artificial Sphincter

The most effective treatment for male SUI is to implant an artificial urinary sphincter device. This device has three parts:

  1. A fluid-filled cuff (the artificial sphincter), surgically placed around your urethra.
  2. A fluid-filled, pressure-regulating balloon, inserted into your belly.
  3. A pump you control inserted into your scrotum.

The artificial urinary sphincter cuff is filled with fluid which keeps the urethra closed and prevents leaks. When you press on the pump, the fluid in the cuff is transferred to the balloon reservoir. This opens your urethra and you can urinate. Once urination is complete, the balloon reservoir automatically refills the urethral cuff in 1-3 minutes.

Artificial sphincter surgery can cure or greatly improve urinary control in more than 7 out of 10 men with SUI. Results may vary in men who have had radiation treatment.

Male Sling for SUI

Similar to female mid-urethral slings, the male sling is a narrow strap made of synthetic mesh that is placed under the urethra. It acts as a hammock to lift and support the urethra and sphincter muscles. Most commonly, slings for men are made of surgical mesh. The surgical incision to place the sling is between the scrotum and rectum.

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