Stress Urinary Incontinence

Do you cross your legs in anticipation of sneezing? Do you wear a pad or pantyliner when you are sick and have a cough? Did you have to give up jumping on trampolines with your kids? Well, if any of these situations sound familiar, you might be suffering from Stress Urinary Incontinence (SUI).

Table of Contents

What is sui?

It is a leakage of urine associated with physical activities like coughing, sneezing, laughing, or lifting anything heavy. Some women experience loss of only a small amount of urine while some lose a large volume. 

Why is it important to recognize this condition?

Because treatments that can improve the quality of your life are available.

Why does sui happen?

SUI happens when the urethra, the tube that drains the bladder to outside world, loses its support and can’t prevent urine from leaking from the bladder. As a result, when abdominal pressure increases with coughing, heavy lifting or any activity that feels like a sit up, urine comes out. 

what causes sui?

The most common reason why SUI develops is due to trauma to pelvic floor muscles and ligaments. One of the major causes is giving birth vaginally because it weakens the support of the urethra. Women who have not given birth but experience SUI likely suffer from chronic constipation that predisposes their pelvic floor to chronic and prolonged increased pelvic pressure that eventually damages the urethral support. Other women might have a connective tissue disorder that makes them and the ligaments supporting the urethra very flexible. Another reason is pelvic floor dysfunction, a condition that develops if the pelvic floor muscles are too weak or too overstretched and not functioning properly. 

If the described symptoms sound familiar, and you are sick and tired of living with it, there is a solution! I will share with you several simple ways to manage the symptoms of SUI. 

Make sure you empty your bladder before anticipated physical activity. 

You can also insert a large tampon into the vagina—it will compress the urethra and help with leakage. If a simple tampon does not fit properly, there is a special device called Impressa that is specially designed to stay in the vagina and compress the urethra to decrease urinary leakage with physical activity. 

Next, training your pelvic floor muscles can improve leakage, and there are several ways to train them.

You can do Kegels on your own. Try to isolate the correct muscles by imagining you are about to pass gas, but you are trying to hold it. Those are the exact pelvic floor muscles you should use to do Kegels. Hold each contraction for 10 seconds, and try to do a set of 10 at least twice a day. 

If you are having difficulty identifying the correct muscles, you can try a biofeedback device. It’s a probe that inserts into the vagina and connects to a phone app, which shows you the strength and effectiveness of your contractions. 

You can also search for a pelvic floor therapist in your area and set up an appointment. Pelvic floor physical therapy is amazing at helping women identify the correct muscles, helping  to work the muscles that need it and relax those that need to be relaxed. 

Another modification that has proven to be successful is weight loss. Losing between 5 to 10% of your body weight provides significant improvement in SUI! The reason behind it is that by removing extra weight from the stomach area, extra pressure on the urethra also decreases, improving SUI.

If you still have symptoms despite emptying your bladder, doing Kegels, losing weight, and trying physical therapy, it’s time to see a urogynecologist. 

Because SUI mostly occurs due to injury in the support system of the urethra, the tube that drains the bladder to outside world, interventions usually target rebuilding the support system. 

For example, urethral bulking agents are fillers similar to face fillers that buff up the urethra. They create resistance and prevent urine from leaking out when there is increase in abdominal pressure (like coughing, sneezing, jumping, or lifting anything heavy). During the procedure, the bulking agent, which can be made out of calcium or gel, is injected into the urethra under the direct visualization of a small camera. This procedure can be done either in the office or in the operating room, depending on your pain tolerance. Because the procedure takes literally two minutes, the majority of women do not have any problem having this procedure done in the office with some Valium and topical numbing. The bulking agent is an excellent choice for women who have mild to moderate urinary incontinence and those who desire to avoid/or cannot tolerate a surgical procedure due to their overall health. 

Does Urethral Bulking Last forever

Unfortunately, it doesn’t. The material that bulking agents are made of usually are either expelled from the urethral lining or becomes resorbed. So with time, women will either need a repeat injection or move on to other more durable options. 

What is normal after you had a urethral bulking agent injected?

– You might have some blood in your urine, or your urine might look pink. 

– You might see pieces of crystal or material in your urine when you pee. This is normal and does not mean that ALL the injected material is coming out.

– You urinary stream might change or spray. Even though it might cause some inconvenience, it is not harmful, and it can be partially corrected with adjusting your position on the toilet. 

– If you have imaging studies done like a CT scan, MRI or X-ray, material from the fillers will show up. Often, doctors who read your image might not realize that the “calcifications” or “masses” that they see are actually your fillers. Make sure to let your doctors know because it will save you from additional unnecessary testing. 

What if you try fillers, and they help for some time, and then your leakage returns? 

Or what if you just want the most durable and long-lasting treatment to get back to the things you enjoy doing the most?

The most durable procedure for treatment of SUI is a urethral sling.

A urethral sling is a piece of a material that is placed vaginally and designed to support the urethra like a hammock to prevent leakage. Different materials are used for slings: your own fascia, cadaveric fascia, and synthetic mesh. Synthetic mesh is considered the gold standard for treatment of SUI. During this procedure, a small incision is made inside of your vagina and the sling is inserted. The procedure takes about 20 minutes, but it’s done in the operating room because of the need for anesthesia. Recovery is pretty quick because no big incisions are required. 

Do you need to have a catheter after surgery?

Usually not. However, sometimes due to the tissue swelling surrounding the urethra, patients can’t void right away. In that case, a catheter will be placed with the goal to drain urine until swelling goes down—usually a day or two. Even though having a catheter can be uncomfortable, it’s important to remember that it’s temporary and to focus on the big picture of getting rid of incontinence and getting one step closer to having your life back with all the activities you enjoy. 

It is time to live your best life, and that is no place for SUI.

Stress Urinary Incontinence

Schedule an Appointment

If you’re interested in learning more about your options for Stress Urinary Incontinence treatments, your first step is to schedule an appointment with Dr. Dubinskaya. To get started, contact our office by calling 424-210-9030 or filling out our online form.

MEET Dr. Alexandra Dubinskaya

A leader in women’s sexual health

Dr. Alexandra Dubinskaya is a board-certified, fellowship-trained Urogynecologist and Sexual Health specialist whose mission is to enhance women’s quality of life by improving their pelvic and sexual health. Dr. Dubinskaya’s focus is on making a difference in people’s lives through state-of-the-art, compassionate, and personally tailored care.

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