Stress Urinary Incontinence

It's Time to Talk About SUI

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Stress urinary incontinence (SUI) happens when you experience an involuntary urine leakage with physical activity, coughing, sneezing, or other actions that put pressure on the bladder. Experts say stress urinary incontinence affects one in three women at some point in their lives.

Stress urinary incontinence is seldom talked about due to embarrassment and stigma, but when it leads women to restrict physical exercise, fitness walking and other activities, it is time to start talking.

Symptoms of Stress Urinary Incontinence

Urine leakage in SUI can range from a few drops to a heavier release of urine. Some women experience SUI only during high-impact activities, such as jumping, or high-stress actions, such as sneezing. But other women have urine leakage during moderate activities, such as walking or getting out of a chair. SUI is different from urge incontinence and overactive bladder syndrome.

Who Has Stress Urinary Incontinence? One in Three Women

SUI is more common in older women but it also affects younger, active women. Risk factors for SUI include being overweight or obese, smoking or having a chronic cough. SUI more common in women who have gone through pregnancy and childbirth. Nerve injury and pelvic surgery can also increase the risk of SUI. Experts say one in three women experience SUI at some point in their life.

While many women experience SUI, it shouldn't be considered to be a normal part of aging or a sign of aging.

Getting Help for Stress Urinary Incontinence

Many women use mini-pads or incontinence pads as a simple way to address SUI. But once they realize that they are limiting their physical activity or social life due to SUI, it is time to seek help.

Self-Assessment: The American Urological Association Foundation has a patient resource page with a self-assessment tool, patient guide to SUI, frequently asked questions, and tips for talking to your doctor about SUI.

Bladder Diary: Keeping a diary of your fluid intake and urine output can help your doctor understand and assess your problem. The AUA Foundation has free instructions and a printable bladder diary online.

The Right Doctor: A primary care physician may be able to provide the needed help, and may offer several conservative solutions. There are no medications that are used for SUI. But if SUI is a problem that is restricting your lifestyle and you need a permanent solution, there are surgical procedures that can address it. Ask for a referral to a urinary incontinence specialist if your primary care doctor isn't giving you a solution that enables you to live as you wish to live.

Conservative Solutions for SUI

  • Try Pelvic floor muscle training.
  • Maintain healthy weight.
  • Fluid and diet management: restricting caffeine and acidic drinks and some foods, such as chocolate and citrus fruit, can help some patients. Drinking just the right amount of fluids each day -- not too little and not too much -- is important for good health, reducing constipation and not overloading the bladder.
  • Stop smoking and treat chronic coughs.
  • Urinary control devices: These can be as simple as wearing a tampon. But there are other devices available, such as urethral inserts and patches and a vaginal incontinence pessary.

Surgical Solutions for SUI

  • Urethral bulking: This is an office procedure where substances are injected through a cystoscopic procedure to bulk up the urethral muscles. It often must be repeated.
  • Bladder neck suspension: This is a more invasive surgery to reposition the bladder neck behind the pubic bone.
  • Slings: This procedure is now the most common and is done through the vagina rather than an incision. Strips of material are placed beneath the bladder neck and urethra to support them in a hammock. The material can be synthetic or the women's own tissue. This procedure has a faster recovery time than the bladder neck suspension surgery.

An important point to remember: Delaying surgery doesn't reduce good outcomes.

Sources:

Stress Urinary Incontinence: A Monograph from the AUA Foundation, May 16, 2011, American Urological Association Foundation.

Luber, K.M. (2004). The definition, prevalence, and risk factors for stress urinary incontinence. Reviews in Urology, 6 (Suppl 3), S3-S9.

Hampel, C., Weinhold, D., Benken, N., Eggersmann, C., & Thuroff, J.W. (1997). Definition of overactive bladder and epidemiology of urinary incontinence. Urology, 50(6A Suppl), 4-14.

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