Stress Urinary Incontinence

  • Stress urinary incontinence (SUI) is leakage of urine due to pressure onto the bladder for example when you cough, sneeze or run.

  • It occurs when there is not enough closure of the urethra to counteract the pressure coming down.

Causes

  • SUI can occur during pregnancy as there is more pressure on your bladder from your baby as well as following child-birth, particularly vaginal delivery, due to the stretch of the pelvic floor muscles.

  • It can also start around menopause due to decreasing oestrogen levels as well as later in life due to decreased muscle mass associated with ageing.

Signs & Symptoms

  • You will feel loss of urine when you cough or sneeze or another form of exertion and/or your underwear may feel wet. Some people will need to wear a continence pad due to the amount of leakage.

Differential Diagnosis

  • Overactive bladder

  • Pelvic organ prolapse often co-exists with SUI

PROmotion Assessment 

  • To resolve SUI, your pelvic floor muscles need to be strengthened through exercises. When your pelvic floor muscles are stronger, they work to close the urethra even against strong pressure such as coughing and sneezing so that no urine can escape.

  • Some women need to either increase or decrease the amount of water they are drinking. This can be determined through the results of the bladder diary.

  • Weight loss through diet and exercise is an important part of management.

  • Women who are going through menopause may also need to use oestrogen cream prescribed from their GP.

How to Manage

  • To resolve SUI, your pelvic floor muscles need to be strengthened through exercises. When your pelvic floor muscles are stronger, they work to close the urethra even against strong pressure such as coughing and sneezing so that no urine can escape.

  • Some women need to either increase or decrease the amount of water they are drinking. This can be determined through the results of the bladder diary.

  • Weight loss through diet and exercise is an important part of management.

  • Women who are going through menopause may also need to use oestrogen cream prescribed from their GP.

References

  1. Dumoulin C, Hunter KF, Moore K, Bradley CS, Burgio KL, Hagen S, et al. Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: Summary of the 5th international consultation on incontinence. Neurourol Urodyn. 2014;  DOI:10.1002/nau.22677.

  2. Dumoulin C, Hay-Smith EJ, Mac Habee-Seguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2014; 5:Cd005654.  DOI:10.1002/14651858.CD005654.pub3.

  3. Bo K. Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World J Urol. 2012; 30(4):437-43.  DOI:10.1007/s00345-011-0779-8.

  4. Bo K. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int Urogynecol J Pelvic Floor Dysfunct. 2004; 15(2):76-84.  DOI:10.1007/s00192-004-1125-0.

  5. Bozkurt M, Yumru AE, Şahin L. Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor. Taiwanese Journal of Obstetrics and Gynecology. [cited 2015/04/20]; 53(4):452-458.  DOI:10.1016/j.tjog.2014.08.001.