Page 1 - Stress Urinary Incontinence

Urological Health
Stress urinary incontinence
Stress urinary incontinence occurs frequently in women, rarely leading to other medical
problems, but often impairing one’s quality of life. Treatment is available to restore control.
tress urinary incontinence (SUI) is the involuntary
Sleakage of urine during activities such as
coughing, sneezing, sudden changes in position or
sports. It affects at least one-third of women and can
significantly impair their quality of life.
The bladder normally stores urine until emptying is
desired. SUI is thought to result from the weakening of
the supportive tissues surrounding the urethra (urinary
passage), which results in urine leakage during
straining.
Stress incontinence differs from other forms of urinary
incontinence (“leakage”) including:
• urgency incontinence, where urine leakage occurs
with an uncontrollable urge to void,
• overflow incontinence, where an overfull bladder
leaks because it cannot store any more urine.
Some women may have a mixture of several kinds of
urinary incontinence.
Your urologist will clarify your incontinence problem by
asking questions and performing some investigations.
Different forms of urinary incontinence require quite
different treatments.
Contributing factors
Several factors increase the chances of developing
SUI, including:
1. childbirth, especially multiple pregnancies,
prolonged labour, and larger babies
2. age and menopause, with loss of female hormones
3. pelvic surgery (e.g., hysterectomy, vaginal surgery,
rectal surgery)
4. excess weight gain
5. smoking
6. radiation therapy
7. obesity
Investigation of SUI
The investigation of SUI begins with a thorough
questioning regarding your normal voiding pattern
and problem of urinary leakage. The timing and
frequency of your accidents and your need to wear
protection should be clarified.
Your doctor may examine you with a full bladder
and ask you to cough and strain to demonstrate the
incontinence. Measurements may be taken of your
bladder capacity, your urine flow, and how well you
empty your bladder.
A urine sample may be obtained to exclude bladder
infection and other urinary problems. Other more
sophisticated tests may be required in some cases
and will be explained by your doctor. This may include
a visual examination of the bladder (cystoscopy).
Urodynamic assessment may be recommended
where pressures in the bladder and its outlet are
measured during filling, emptying and straining.
Non-surgical treatment of SUI
Non-surgical measures such as pelvic floor exercises
(Kegel exercises), biofeedback, physiotherapy, weight
loss and smoking cessation may be helpful.
Medications may be useful to control some of the
problems that accompany SUI. Estrogen (female
hormone) replacement in postmenopausal women
may restore the quality of the tissues around the
urethra. If bladder overactivity with abnormal
frequency and urgency of urination is also present
with SUI, it may improve with medication.
Some women benefit from wearing a vaginal ring or
pessary, much like a contraceptive diaphragm, to
support the bladder.
Injection of material (e.g., collagen) around the
urethra may be helpful in some patients. Repeat
injections may be required.
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