What Is Stress Urinary Incontinence
Stress urinary incontinence (SUI) is the most prevalent form of incontinence among women. It affects an estimated 15 million adult women in the U.S. And yet most of us would be hard-pressed to explain what it really is all about...
Incontinence is a broad term that applies to any involuntary leakage of urine. And it may surprise some readers to learn that there are different kinds of incontinence. Depending on the cause of urinary incontinence in women, its name and the treatment may differ. Learn more about the different kinds of urinary incontinence in women here.
Stress incontinence happens to be the most common form of incontinence among women, but incontinence is not just a female issue. However, it is twice as common in women as it is in men. The main reasons for this are pregnancy, childbirth and menopause.
Is Stress Urinary Incontinence Linked to Emotional Stress?
The name of stress incontinence is a little misleading, so let’s clear that up right away: Stress incontinence has nothing to do with emotional stress.
Granted, we all feel stress in today’s modern world and it certainly impacts our physical and emotional wellbeing and exacerbates many ailments. But in the case of ‘stress incontinence’ the stress refers to another kind of stress; bodily stress.
Our bodies experience stress in all kinds of mundane ways that we don’t really think about: When we sneeze, cough or even laugh uproariously, our bodies are exerting a lot of energy and there are a lot of different muscle groups working hard to support these bodily functions.
And, of course, when we exercise we’re ‘stressing’ our bodies—even though we don’t usually use this language to describe the pain-and-pleasure mix of working out. And speaking of pleasure, sexual intercourse is another activity that gives you a workout and involves a lot of muscle groups. It’s these kinds of physical stressors that can cause stress incontinence.
But why would coughing, or sex, or any other physical exertion make you pee involuntarily?! Well, first, let’s understand what happens when pee voluntarily…
What Happens When You Pee Normally?
The things we take for granted, until they go wrong... Peeing is such a basic human function most of us never think about what’s going on in our bodies when we sit down on the toilet.
And it would be natural to think it’s all happening below the waist, but in fact your brain and bladder work together to control urinary function.
The bladder is where urine is stored until you are ready to release it. And the muscles of your pelvis hold the bladder in place. The muscles of the bladder are usually relaxed and hold urine in the bladder and the neck of the bladder is closed.
The urethra is the tube that carries urine from the bladder to outside the body. The sphincter muscles are closed around the urethra. When those muscles do their job, urine does not leak outside the body by accident.
When you are ready to pee, your brain lets the bladder know. This causes the bladder muscles to contract which forces urine out through the urethra. The sphincter also opens up, allowing a flow of urine to pass through the urethra and leave the body.
Incontinence happens when urine leaks outside your control and intention to pee.
What Happens When You Experience Stress Incontinence?
If you’ve ever peed a little when you’ve:
- Had sexual intercourse
- Lifted something heavy or bent over
… those are symptoms of stress incontinence.
Stress incontinence occurs when the body is exerting (or under physical stress) and other muscles or muscle groups (in particular the muscles of your pelvic floor) become compromised or less effective at doing their job, which includes holding in pee.
What Causes Stress Incontinence?
But why would the muscles of your pelvic floor “fail” under the stress of coughing or laughing?
Well, the muscles of your pelvic floor are just like any other muscle in your body. They can be weak because they’re not being exercised. Or they can be injured and so more susceptible to letting you down when the body is stressed—just the way a weak leg might buckle when extra pressure is put on it.
For women, the major cause of damage to the pelvic floor muscles is pregnancy and childbirth. This can cause temporary stress incontinence, while the body is recovering from childbirth for example. But damage caused by childbirth can also cause more persistent stress incontinence. It all depends on the woman, her experience of childbirth, and how her body heals.
But those of us who haven't gone through childbirth don’t get off unscathed. Stress incontinence can also be caused by any surgery that impacts the muscles of the pelvic floor, including hysterectomy.
Moreover, damage to muscles is just one dimension. If your pelvic floor muscles are weak due to lack of exercise or just general aging, you may also experience stress incontinence. This is why Kegel exercises are widely recommended for all women, especially as we grow older.
Are There Other Risk Factors?
In addition to the above causes there are some factors that increase the risk of stress incontinence. They include:
- Being overweight
- Family history
- Other diseases (e.g. diabetes, MS, Parkinson’s Disease)
- Having been through pregnancy and childbirth
- Having undergone certain pelvic surgeries (e.g. hysterectomy)
Okay, Stress Incontinence Is Stressful… How Can I Manage it Day-to-Day?
Yep, stress incontinence may have nothing to do with emotional stress but it sure can cause it.
Indeed, any kind of incontinence can cause a lot of anxiety for those who experience it. Fear of an ‘accident’ can even make some people want to withdraw from company and social gatherings.
While we’ll cover treatment options further down, most will not have a very immediate effect. So, while you explore treatment options with your healthcare provider, you can also explore products to help you stay active and social. Leakproof underwear comes with different absorbency levels, that can hold up to 8 tsp of pee.
Super absorbent Knix leakproof underwear can hold up to 8 tsp of liquid (whether that’s sweat, blood or urine). Products like these can be a game changer for those experiencing female urinary incontinence, allowing them to remain active and social while exploring treatment options.
Should I Talk to My Doctor About Stress Incontinence?
Shockingly, half of women who experience incontinence do not discuss it with their doctor. This could be because of embarrassment, but it could also be the result of a perception that incontinence is just a reality for women (especially women of a certain age).
We always advocate chatting with your doctor about everything that’s going on with your body. There is always a chance - even slim - that it could be a symptom of something more serious.
But more than that, your doctor is likely a better judge of what kind of incontinence you have (even if you suspect it’s stress incontinence). At the worst, they’ll confirm what you already think and you can start a discussion about treatment options. So what’s there to really fear?
When you do make the time to talk to your doctor, it helps to be prepared. Write down the questions you want to ask and anticipate the questions they might ask you!
Urinary Incontinence: Question Prep
These are some of the questions your doctor may ask about your experiences of female urinary incontinence:
- How long have you been experiencing these symptoms?
- Have your symptoms been continuous or occasional, have they worsened over time?
- How often do you need to urinate?
- When (time of day or night) do you leak urine?
- Is it difficult for you to empty your bladder?
- Have you noticed any blood in your urine?
- General lifestyle questions: Smoking, diet, alcohol and caffeine consumption etc.
And here are some questions you might ask your doctor:
- What type of incontinence do I have?
- What is causing my urinary incontinence
- What tests should I expect?
- Should I make lifestyle changes, like:
- Bladder diary
- Kegel exercises
- Timed bathroom breaks
- Diet changes, etc.
- What treatment(s) do you suggest for me and why?
- Without treatment, what will happen?
- What are the side effects or risks associated with this treatment plan?
Incontinence is not an easy thing to experience, but there are treatment options and lifestyle changes that can make it easier to live with incontinence.
Treatments Your Healthcare Provider May Recommend or Explore
Once your healthcare provider has diagnosed stress incontinence, they will discuss treatment options with you. As with many medical diagnoses, there will be a range of options for you to consider.
In addition to treatments, your doctor may recommend certain lifestyle changes.
Some medical practitioners start first and foremost with lifestyle changes as they are usually minimally invasive and have positive impacts not just for the condition at hand but for general wellbeing.
Other medical practitioners understand that these changes can take considerable effort and may not be possible for everyone to adhere to long term. If you are committed to avoiding more invasive procedures and want to explore lifestyle changes first, communicate this clearly with your doctor and make a plan to measure progress, which can be slower and less perceptible than with drugs and other treatments.
1. Kegel Exercises / Exercises for Pelvic Floor Muscles
These exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum.
Good news: Kegel or pelvic floor exercises can be done any time, either sitting or lying down. You can even do them when you are eating, sitting at your desk, or when you are resting or binging your favourite show on Netflix!
If you’re unsure how to do Kegel exercises, your doctor or physiotherapist can help you. But basically it’s like pretending you have to urinate and then holding it. You relax and tighten the muscles that control urine flow.
One way to learn the muscles you should activate is to pay attention when you pee: Start to pee and then stop. You should feel the muscles in your vagina (for women), bladder, and anus get tight and move up. These are the pelvic floor muscles.
If you feel them tighten, you have done the pelvic floor muscle training right. Your thighs, buttock muscles, and abdomen should remain relaxed.
2. Reducing Risk Factors
While you can’t undo past surgeries or childbirth, some of the factors that put you at risk of incontinence can be lessened by making considerable lifestyle changes. In particular, maintaining a healthy weight and quitting smoking are changes you may be able to commit to.
It’s worth committing to a healthy lifestyle more generally — not just to reduce risk of incontinence. But it’s also worth noting that a healthy lifestyle is no guarantee you won’t be affected by illness or medical concerns, including incontinence.
Other Medical Solutions for Stress Urinary Incontinence
Fluid Consumption & Bladder Training
Your healthcare professional may also recommend making changes to the fluids you consume, and when you consume them. Of course, it’s important to stay hydrated. But they may suggest cutting back on caffeinated, carbonated beverages and/or alcohol. If these simple changes have an effect, it will be a personal decision whether to make more permanent dietary changes.
In addition to curtailing certain beverages, your doctor may advise bladder training. This involves taking bathroom breaks at regularly timed intervals. By ensuring your bladder is emptied frequently, you minimize the chances of leakages. Over time, the time between breaks can be increased. This course of action might be especially effective for those with mixed incontinence.
Devices that can be used to control stress incontinence include vaginal pessaries and urethral inserts.
- Vaginal Pessary: This is a soft, removable device that is inserted in the vagina. It supports areas that are affected by pelvic organ prolapse (POP).
- Urethral Insert: A small tampon-like disposable device inserted into the urethra acts as a barrier to prevent leakage, while still allowing you to pee.
Finally, under certain circumstances, your doctor may recommend surgery. These will usually help strengthen the bladder neck or improve closure of the sphincter.
Surgical options include:
- Sling procedure
- Injectable bulking agents
- Retropubic colposuspension
The sling procedure is the most common surgical procedure performed in women with stress urinary incontinence. This procedure entails the surgeon using the person's own tissue, synthetic material, or donor tissue to create a ‘sling’ or hammock that supports the urethra. Learn more about it from the Mayo Clinic.
Surgery often offers a more long term solution to involuntary urine leaks. However, as with any surgery, there are risks to explore and you might want to try exploring other options before you undergo surgery.
Clearly, there are many treatment options for treating stress urinary incontinence (SUI) and the right course of treatment for you will depend on the severity of your condition. This is something you and your healthcare provider will navigate together.
Don’t let fear or embarrassment lead you to suffer in silence. Know that many women (and men) experience incontinence, for many different reasons, and it is impossible to fully understand your symptoms or self-diagnose. So chat with your doctor and get a full and proper diagnosis before you jump to any conclusions.
In the short-term, try leakproof underwear to help you manage incontinence day-to-day. While these will not cure incontinence, they will help you feel like you can carry on living, exercising, socializing etc. in the manner you did before without carrying a constant fear of “accidents”.