Stress Urinary Incontinence

Urinary incontinence occurs when there is involuntary loss of urine.  Stress urinary incontinence (SUI) refers to the loss of urine when doing things such as laughing, sneezing, coughing, jumping or lifting a heavier object. When one performs these actions there is an increase in pressure in the abdomen. If this pressure rise exceeds the pressure in the urethra (tube which allows you to urinate), there is involuntary loss of urine.

Under normal circumstances, the urethra functions as a valve and maintains a pressure higher than the pressure in the bladder and abdomen. This prevents loss of urine. There are many reasons why the pressure in the urethra drops and leads to SUI.  A focused evaluation can identify these reasons.

An appropriately detailed evaluation of urinary incontinence is important and usually requires more than one office appointment to determine the causes. Since female urinary incontinence typically has a profoundly negative impact on a woman’s quality of life, this situation deserves to be evaluated by a qualified medical professional.

Factors that may contribute to or cause SUI:

  • Vaginal childbirth
  • Loss of urethral support
  • Decrease in estrogen (occurs after menopause)
  • Defect in the sphincter (valve) mechanism of the urethra
  • Genetic predisposition to weakness in support structures around the urethra


Symptoms:

Loss of urine when performing activities that increase abdominal pressure such as:

  • Laughing
  • Sneezing
  • Coughing
  • Exercising


Treatment Options
:

Conservative/Non-surgical:

  • Pelvic Floor Muscle Exercises (Kegels)
  • Pelvic Floor Rehabilitation
  • Pessary (device inserted into the vagina for support)
  • Vaginal estrogen supplementation

Surgical:

  • Urethral “lift” (Burch procedure)
  • Sling procedures:
    - TVT type slings
    - Transobturator
    - Single incision slings (through vagina only)