Stress Urinary Incontinence

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.