Incontinence is simply a term for urinary leakage, and people may experience it for various reasons. Stress incontinence is when unintentional leakage happens with movement or activity, such as sneezing, exercising, laughing, coughing, or walking.
Understanding how the bladder functions can shed some light on why incontinence happens. Your bladder is designed to store a small amount of urine, up to 16 ounces, so it remains relaxed as it fills with the metabolic waste your body produces. As it fills, the urethra, the tube through which we urinate, remains contracted and closed.
When we want to urinate, a coordinated set of actions occurs: the bladder contracts to initiate the flow of urine, and the urethra and pelvic muscles must relax and open to allow the urine to flow out. When you sneeze, cough, or exercise, the increased abdominal pressure from these activities overwhelms the urethra, allowing urine to escape.
So, what goes awry when somebody has stress incontinence? Either the urethral sphincter muscle is too weak, or the urethra itself is floppy and not well-supported, which can result from childbirth or simply aging.
Chronic constipation and other factors can also contribute. Repeated straining during bowel movements increases intra-abdominal pressure, which in turn places additional stress on the pelvic floor muscles and supportive tissues around the bladder and urethra. Over time, this can weaken the pelvic floor and compromise urethral support, making it more difficult for the sphincter to remain closed. Menopause, as declining estrogen levels affect tissue elasticity, and obesity, which adds constant downward pressure, may compound the problem as well.
Diagnosing SUI
To diagnose SUI, your doctor may perform a physical exam, ask about your symptoms, and/or order various tests. Tests that may be ordered when SUI is suspected include urodynamic studies, a urinary stress test, urinalysis, pelvic ultrasound, and cystoscopy.
Based on the results of these tests, your doctor will recommend various treatment options.
Treatment for SUI
You are not alone in suffering from this problem—over one-third of women may experience stress incontinence at some point in their lives. Unfortunately, it can significantly impact one’s quality of life, leading to depression, low self-esteem, anxiety, skin problems from leakage, an increased risk of urinary tract infections, and social embarrassment. The economic impact is also considerable, with the added costs of pads, diapers, and laundry supplies.
The good news is that effective treatments are available. Treatment options don’t look the same for everyone – they depend on severity, age, and the presence of other medical issues.
Sometimes, a combination of treatments is needed for the best results. Supportive measures may include:
Lifestyle changes: Maintaining a healthy weight to reduce abdominal pressure, quitting smoking, and managing chronic coughs (such as those from COPD or asthma).
Pessaries: Small, soft medical devices placed inside the vagina to help support the bladder, urethra, or other pelvic organs. (Learn more about pessaries.)
Pelvic floor exercises: While often underutilized, strengthening the pelvic floor can compensate for a weak urethral sphincter. Many people are unsure how to perform a correct Kegel exercise, but a therapist can provide valuable guidance.
The gold standard for treating female stress incontinence is the placement of a synthetic sling under the urethra. This helps support the urethra and increase resistance against leakage. This surgery has a high success rate, but it is an outpatient procedure requiring four to six weeks of recovery. As with any surgery, there are risks, including temporary or long-term urinary retention, bladder injury, and, in rare cases, chronic pelvic pain. (Learn more about the female sling.)
Regain Confidence with Georgia Urology
Stress urinary incontinence doesn’t have to control your life. At Georgia Urology, our team offers tailored treatment options, ranging from lifestyle guidance and pessaries to physical therapy referrals and surgical solutions, such as the female sling. We frequently refer patients to pelvic floor PTs to ensure exercises are done correctly and effectively.
