Picture this. As a woman and parent, you are playing outside with your kids on the trampoline, but you notice your underwear is soaked after jumping around. Many recreational activities lead to bladder leakage caused by stress urinary incontinence, including laughing or coughing.
Unfortunately, many women feel this is a normal part of life. But, no woman should feel like their daily routine means ‘just dealing with’ 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 SUI, 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
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 weight lifting.”
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.”
Here is a quick video on how to properly perform a Kegel.
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.”
If you think stress incontinence is controlling your life, contact your primary provider for a referral to urogynecology.