If you have bladder leakage when you sneeze, cough, laugh or during physical activity, you may have stress urinary incontinence.

There are various types of urinary incontinence. However, stress urinary incontinence, also known as SUI, and overactive bladder affects about 20-25% of women, depending on factors like childbirth, age and other pelvic floor disorders like prolapse.

While SUI is a highly-prevalent condition in women, excellent treatment options are available to help manage the condition and improve your well-being.

Stress urinary incontinence causes

SUI is caused by weakness of the pelvic support structures under the urethra.

“Instead of being supportive, these weak tissues cause the urethra to move during activities of increased abdominal pressure, like sneezing, coughing or laughing,” said Jason Cruff, D.O., Marshfield Clinic Health System urogynecologist. “This causes the bladder to push some urine into the urethra, the tube that drains urine from the bladder, and then leakage results.”

You may not experience leakage every time you cough, sneeze, laugh, bend over, exercise or do other forms of movement, but any activity that increases pressure on your bladder can make you more vulnerable to unintentional urine loss.

SUI doesn’t just affect older women

There are many reasons the pelvic floor muscles may weaken, resulting in stress urinary incontinence. Common risk factors include obesity, smoking, vaginal childbirth, chronic coughing or age. SUI also can be associated with other female pelvic floor disorders, like pelvic organ prolapse, because they share similar risk factors.

While age is a risk factor, it doesn’t always mean women of advanced age will develop urinary incontinence. It depends on several factors and is based on the individual.

“It’s important to remember that stress urinary incontinence, in particular, can affect both younger and older women. Women in their 30s can present with SUI, even after just one vaginal delivery,” Dr. Cruff said.

Stress urinary incontinence treatments

There are many excellent nonsurgical and surgical treatments available for SUI.

“The treatments aim to provide additional support to the underside of the urethra to prevent its downward movement and eventual urine leakage,” said Dr. Cruff.

By age 80, approximately one in five women will have surgery for a pelvic floor disorder, including SUI. Surgeries for this condition are minimally-invasive and allow for quick recovery, minimal pain and great long-term outcomes (80 to 90% success rates).

The current, gold-standard treatment for stress urinary incontinence is the midurethral sling, introduced in the 1990s. Since then, the midurethral sling has undergone considerable innovation.

“Now, a small segment of synthetic mesh that is only eight centimeters long and one centimeter wide can be positioned under the mid-portion of the urethra during a simple outpatient procedure,” Dr. Cruff said. “There is a small incision made under the urethra that is about the width of your thumbnail. There are no exit incisions made in the skin and this limits discomfort and risk of bladder injury. If your job is mostly sedentary, you can return immediately after surgery.”

Although non-mesh alternative procedures still exist, using synthetic mesh to treat SUI is very safe, effective and is still considered the standard of care.

“Mesh used for the treatment of SUI is not under the same contention from the FDA like the transvaginal mesh that was used to treat pelvic organ prolapse. Midurethral sling mesh complications are rare and are easily treated if they occur,” he said.

Strengthening your pelvic floor muscles

Kegel exercises done properly and regularly can help to increase pelvic floor strength and tone so that bladder leakage can be improved.

“The key is if they are done properly,” Dr. Cruff said. “You can potentially hinder or worsen SUI if Kegels are not done properly, and you should consult with your doctor for an exam just to make sure that you are in fact performing Kegel exercises properly.”

“I think most of us have heard it – ‘do your Kegel exercises!’ – and yet we, providers, find women are not exactly sure how to do Kegel exercises,” said Yolanta Soroko, a Marshfield Clinic Health System physical therapist and certified athletic trainer.

Soroko recommends a core exercise called “The Bridge” to help build pelvic floor muscles and prevent incontinence.

Additionally, Dr. Cruff recommends some lifestyle changes to help with urinary incontinence. These include limiting your fluids to 60-70 ounces daily, visiting the bathroom more frequent to keep your bladder at a low volume, quitting smoking and maintaining weight through diet and exercise.

“Losing weight is shown to dramatically reduce overall urinary incontinence,” he said. “However, you also want to limit repetitive activities that put an undue amount of stress on the pelvic floor like extreme weightlifting.”

How to do a Kegel

Locate your pelvic floor muscles with a urine stop test:

1. Go to the bathroom and start to empty your bladder.
2. Stop the flow mid-way through emptying.
3. Focus on squeezing the muscles without tightening your gut or butt.

“The urine stop test helps women find their pelvic floor muscles and understand what it feels like to contract those muscles,” Soroko said. “It is not something they should do repeatedly on the toilet. In other words, don’t exercise on the toilet.”

Or, have you ever held in a gas bubble? A Kegel feels a lot like that.

When you start Kegel exercises, it may be difficult to contract your pelvic floor muscles for more than two seconds. As you strengthen your pelvic floor muscles, you’ll be able to work up to 5- to 10-second holds, 5 to 10 repetitions.

“To start, I tell women to aim for 30 Kegel exercises per day,” she said. “Make cues for yourself, like stoplights, grocery lines or waiting to pick up your kids from school.”

Here is a quick video on how to properly perform a Kegel.

How to do The Bridge

1. Lie on your back with your knees bent, feet on the floor and arms at your side (palms flat).
2. Lift your hips toward the ceiling.
3. Hold for 5 seconds.
4. Lower your hips.
5. Repeat 10 times.

See an illustration of The Bridge in Slide 8 of this Shine365 yoga story >

Work through your bridge repetitions every morning before you get ready for the day and at night before you go to bed.

The first step to getting help? Talk with your provider

“The most important thing a woman can do is to open a dialogue regarding her urinary leakage concerns,” said Dr. Cruff. “Women should not suffer in silence. They should feel empowered and comfortable to discuss pelvic floor issues with medical professionals and other women. Any amount of urine leakage is not considered normal and should be promptly addressed.”

When basic exercises do not improve incontinence or you must run to the bathroom more than 10-12 times per day, talk to your primary care provider.

“Your primary care provider can refer you to a specialist in incontinence, depending on your needs,” Soroko said.

Physical therapists evaluate pelvic floor muscles and develop strength and bladder-retraining programs to improve your bladder control. Urogynecology treats a variety of female pelvic floor disorders. Urology can treat issues with urinary incontinence for men and women.

If you think stress incontinence is controlling your life, contact your primary provider for a referral to physical therapy, urology or urogynecology.

For stress urinary incontinence concerns, visit Marshfield Clinic Health System.

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