Female Stress Incontinence

Stress urinary incontinence is a form of incontinence that occurs when urine leaks out of the urine channel during sudden activities such as a cough, sneeze, laugh, or exercise.  In more severe cases, stress urinary incontinence (SUI) can also occur while walking or standing up from a seated position. The amount of leakage can vary, resulting in mild (only minor spotting) to severe incontinence, requiring use of thick pads or diapers. Unfortunately, many women with SUI suffer embarrassment and frustration from their condition and are not aware that there are treatments that can help.

If your urinary control impacts your confidence and freedom,
we can help you pursue successful treatment.

About 1 in 3 women suffer from SUI in the U.S. The risk of experiencing SUI increases with age, pregnancy and childbirth, smoking, chronic cough or sneeze, and weight gain.  About ½ of women with SUI also experience another condition called overactive bladder (OAB). OAB is the name for a group of bladder symptoms that includes urinary frequency, urgency, and urinary leakage that occurs as a result of urgency.  While there is some overlap between treatments that improve each condition, OAB and SUI are typically managed with different therapies.

What factors increase the risk of SUI?

Although many younger women suffer from SUI, age increases the risk of exerpiencing SUI. SUI is also more common after childbirth or pregnancy and risk factors include obesity, smoking, chronic cough, and history of pelvic surgery.

How is SUI evaluated?

Having treated thousands of women with both conditions, Dr. Thompson’s approach is to begin by addressing the condition that causes the greatest bother.  For women with bother from both SUI and OAB or other complex factors, we may consider additional testing to further understand the anatomy and the function of your condition. You may be asked to keep a voiding diary to help demonstrate your pattern of fluid intake and urination. Diagnostic testing can be beneficial in helping us pursue a treatment that addresses your individual situation. Testing may include laboratory evaluation of a urine sample, a bladder scan (an ultrasound that shows how much urine is left behind in the bladder after urination), cystoscopy (examining your bladder with a small camera that is inserted into the urine channel), and urodynamics (a test to assess the bladder function with the use of small catheters into the bladder and rectum).  Once we have a more complete picture of your urinary condition, we may offer advanced treatments for SUI or OAB. For more information on OAB treatment, visit our Overactive Bladder page.

What treatments are available for SUI?

For women with mild SUI and younger women considering future childbirth, Kegel exercises may help strength the pelvic floor muscles and alleviate incontinence. Kegels are performed by contracting or squeezing the muscles around the urethra.  Exercising these muscles can alleviate some of SUI symptoms, particularly for women with less severe incontinence.  Weight loss and smoking cessation have also been shown to reduce the severity of SUI.

Surgery for SUI is often very successful.  Here at Restorative-Urology, Dr. Thompson has treated thousands of women with surgical procedures that alleviate or cure SUI.  There is no benefit to delaying surgery for SUI, and many women express regret that they hadn’t pursued treatment earlier.

Bulking Agents

Bulking agents are injected into the side wall of the urethra, or urine channel. Urethral injections are used to “bulk up” the urethra in order to keep the walls of the urethra closed during activity.  Bulking injections are performed in a 5- minute procedure under light sedation.  The procedure is minimally-invasive and well-tolerated, but repeat injections may be necessary.

Female Slings

The female sling is the most common procedure to treat SUI and offers very high success rates. During this procedure, a small soft piece of material is placed under the urethra to enhance support of the urethra.  While several techniques and materials exist, all types of slings act as a “hammock” under the urethra.  While slings can utilize your own tissue or donor tissue, soft synthetic mesh is the most common material utilized for SUI.   The mid-urethral sling with synthetic mesh is placed in a 20-minute outpatient procedure with excellent success rates.  The most common approach is to insert the mesh through a small incision in the vagina and anchor the arms of the sling through the surrounding pelvic floor tissue.  Some women will experience slower urinary flow and urinary urgency that typically resolves over time.  Because the procedure establishes a new support system under the urethra, a prolonged recovery is required to ensure complete healing and ensure success. We usually recommend 6 weeks of limited physical and sexual activity after the procedure.  Insert video for SUI Sling

For many women, surgical therapy for SUI provides assurance and return to normalcy.