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Stress Urinary Incontinence

Overview | Treatment Options | Questions to Ask Your Doctor | Glossary

Overview

What is Stress Urinary Incontinence?

Stress urinary incontinence, or SUI, is the body's inability to prevent accidental leakage of urine when pressure is exerted on the abdomen. It can result from weakened muscles supporting the bladder or urethra. And it can seriously affect your life, making it difficult to do the things you love—or even the things we take for granted in everyday life, such as coughing, sneezing, laughing, or climbing the stairs, without getting wet.

It's common.

Over 13 million American women experience some sort of urine leakage. And SUI is the most common type.

It's nothing to be embarrassed about.

Some people lose their ability to see without glasses. Others lose their ability to hear. Just like any other system in your body, the urinary tract can stop functioning optimally. And that's nothing to be ashamed of.

It's not inevitable.

People used to think SUI came with the territory of aging. But the truth is, it's a condition that affects both young women and old, and can be related to a number of factors, including pregnancy, vaginal childbirth, strenuous exercise, menopause, and gynecologic surgery. And unfortunately, ignoring it can't help and won't make it go away.

It's treatable.

Stress urinary incontinence isn't a disease; it's a condition that can be successfully treated. And that's the good news.

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Treatment Options for Stress Urinary Incontinence

How is stress urinary incontinence (SUI) treated?

85%-90% of all stress urinary incontinence can be successfully treated. That means that it is possible to regain your independence, and return to an active, healthy lifestyle.

There are a variety of treatment options for SUI.

Behavioral therapy helps retrain the bladder and sphincter muscles.

Bulking therapy is an innovative, non-surgical procedure to implant a bulking agent—either natural collagen protein or another biocompatible substance—into the tissues surrounding the urethra/bladder junction to help reinforce the closure mechanism and prevent accidental urine leakage.

Surgery helps rebuild the urinary system's architecture to restore normal bladder function. One of the most effective surgical treatments for SUI is the surgical implantation of a urethral sling. It involves placing a slender strip of material underneath the urethra to help support your natural tissues. It's minimally invasive, and is one of today's most successful procedures. In fact, hundreds of thousands of slings have been implanted worldwide.

What causes stress urinary incontinence (SUI)?

Stress urinary incontinence is a sign of an underlying condition often characterized by one or more of the following:

Poorly functioning urethral sphincter muscle, the smooth muscle which helps to form a seal at the neck of the bladder.
Excessive movement of the female urethra, the muscular tube that allows urine to flow from the bladder to the outside of the body
Weakened muscles which no longer adequately support the bladder and other organs of the pelvic area.

For women, these conditions may be influenced by a number of factors that can lead to incontinence, including:

pregnancy and/or natural childbirth
strenuous exercise
loss of pelvic muscle tone
previous gynecologic surgery

In men, stress incontinence generally results from previous surgical procedures (such as a radical prostatectomy, the removal of a diseased prostate) or accidental trauma.

Is SUI an inevitable part of the aging process?

While SUI is common in older people, it is not a natural or inevitable part of the aging process. In fact, millions of older people naturally maintain their continence while millions more have been helped with successful procedures.

Is incontinence a natural part of bearing children?

Pregnancy and childbirth take a toll on a woman's body. The months of extra weight in the pelvis and the stretching and possible tearing of tissues during delivery have been known to damage structures that help support the bladder and maintain control of urine. Having babies may contribute to incontinence, but it doesn't mean you have to be incontinent. Today's treatments offer excellent success rates; and many women who started leaking after childbirth are dry today.

Can my SUI be treated even if I plan to have more children?

Absolutely. Minimally invasive bulking therapy has helped hundreds of thousands of women restore continence. And it doesn't preclude the possibility of having surgery at a later date.

Am I too old to be treated for incontinence?

You're never too old to receive medical attention for incontinence. The types of incontinence older people have, and their responses to treatment are quite similar to younger patients.

How do I know if I'm incontinent?

Only a trained specialist like a gynecologist, urologist or uro-gynecologist can diagnose SUI. However, if you can answer "Yes" to any of the following questions, you may be experiencing urinary incontinence.

During a typical day, do you leak even small amounts of urine?

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

Do you often have such a strong urge to urinate that you experience leakage before you reach the toilet?

Are you experiencing leakage after surgery?

How can I find a doctor who treats incontinence?

Your primary care physician can refer you to a gynecologist, uro-gynecologist or urologist who can help diagnose and treat urinary incontinence.

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Questions to Ask Your Doctor About Stress Urinary Incontinence

What type of incontinence do I have?

What will happen if my incontinence is not treated?

What treatment choices do I have?

What is the likelihood that I'll be dry after treatment?

How many treatments will I need?

What type of anesthesia, if any, will I need for this procedure?

What is the risk for complications and what types of complications are associated with this particular procedure?

How much will my treatment(s) cost?

Will I need to stay overnight in the hospital?

How much time will I need to fully recover?

Is there anything I won't be able to do after treatment, like sports?

How many of these types of procedures have you completed? What's your success rate?

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Stress Urinary Incontinence Glossary

The following terms will help you understand what your doctor tells you about your urinary incontinence, and your possible treatment.

Acute incontinence

The sudden onset of episodes of involuntary loss of urine, usually associated with an acute illness or physical inability to reach a toilet or toilet substitute.

Allograft

Source is from the same species.

Acute incontinence	The sudden onset of episodes of involuntary loss of urine, usually associated with an acute illness or physical inability to reach a toilet or toilet substitute.
Allograft	Source is from the same species.
Anterior	Front side.
Autograft	Source is from the patient's own body.
Bladder Capacity	Amount of fluid bladder can hold.
Bladder Compliance	Ability of bladder to expand to accommodate urine.
Coaptation	The adjustment of separate parts to each other, as in two sections of tissue.
Continuous in-dwelling catheterization	Catheterization in which the catheter is left in the patient for several days at a time without changing. It is connected to a collection bag, which has to be emptied regularly.
Cystocele	Bladder herniating through a defect in the Anterior Vaginal Wall.
Cystometrogram	Measurement of pressure in bladder in relations to volume of fluid.
Cystometry	The study of bladder filling and storage.
Detrusor	The outer, largely longitudinally arranged musculature of the bladder wall (also referred to as the detrusor muscle).
Distal	Far from the point of attachment or origin.
Diverticula	Pouch-like bulges through the muscular wall of a tubular organ. (The singular is "diverticulum.")
Dysinergia	Condition in which bladder and urethra muscles contract at the same time.
Electromyography	The recording and study of skeletal muscle activity, specifically the external sphincter and perineal floor musculature, by means of surface or needle electrodes to determine whether the muscle is contracting.
Enterocele	Small intestine herniating through a defect in the Apex of the vagina.
Erection	The state of the penis when it is enlarged due to increased blood flow; this most often occurs during sexual excitement.
Estrogen	Hormone given to restore elasticity and thickness to the urethral mucosa.
External sphincter	The voluntary, striated skeletal muscle sphincter derived from the musculature of the urogenital diaphragm.
Fascia	Sheet of fibrous connective tissue appearing beneath the skin and enveloping vessels, nerves, glands, and forming tendon sheaths.
Fibrous	Containing, consisting of, or resembling fibers.
Functional incontinence	Incontinence due to an inability to reach a toilet at the appropriate time. This typically occurs in patients who are confined to a bed due to a physical impairment such as broken bones.
Hematuria	The presence of blood or blood cells in the urine.
Internal meatus	The internal opening between the bladder and the urethra.
Internal sphincter	The involuntary smooth muscle sphincter.
Intravesical Pressure	The total pressure inside the bladder; it consists of three components: detrusor pressure, intra-abdominal pressure, and hydrostatic pressure due to the weight of urine in the bladder.
Intrinsic sphincter deficiency	Type of stress incontinence attributable to (ISD) sphincter muscle incompetence. It is also known as poor or nonfuctioning urethral closure mechanism, or Type III stress incontinence.
Leak Point Pressure	Abdominal pressure exerted in the bladder required to make a patient leak
Paravaginal defect	Defect to the side wall of the Vagina.
Pelvic Prolapse	The herniation of various portions of the vaginal wall.
Plication	To suture together.
Post Void Residual	Amount of urine left in bladder after voiding.
Posterior	Back side.
Pubovaginal Sling	Procedure for the treatment of stress incontinence in which the urethra is suspended with a piece of tissue or synthetic material
Rectocele	Rectum herniating through a defect on the Posterior Vaginal Wall.
Sacral	An area in relation to the base of the vertabral column.
Stress Incontinence	Involuntary loss of urine due to abdominal pressure.
Urethra	The tube that carries urine from the bladder to outside the body; in males, its also the channel through which semen is ejaculated.
Urodynamics	Study of the function of the urinary tract and its associated nervous system.
Xenograft	Source is another species.

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Reprinted with permission from Neil Baum, neilbaum.com

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