Reviewed by: Missy Nolan

Stress Urinary Incontinence (SUI): Symptoms, Causes, Treatments

A diagnosis of incontinence can be difficult to cope with, but the good news is it's a manageable condition. If you've been diagnosed with stress urinary incontinence (SUI), the important thing to remember is that you are not alone. SUI is the most prevalent form of urinary incontinence in women, and it's estimated that between 4% and 35% of adult women live with it. Men may also develop SUI, but it's much less common. Most people with SUI are older women.

Stress urinary incontinence is a condition in which urine unintentionally leaks during activity or when there is stress on the bladder. This can happen when sneezing, laughing, coughing, or engaging in strenuous exercise. Leakage happens because the pressure on the bladder and urethra results in the sphincter muscles opening briefly, which allows urine to escape. The amount of urine leaked can range from a few drops to enough of a gush to soak your clothes.

SUI can have a major impact on your daily activities and mental health. It can lead to emotional distress if it happens in public or around loved ones, potentially disrupting your social life and work. Some people may also be embarrassed by requiring incontinence products to manage their condition. Other potential impacts include:

• Anxiety of being too far from a restroom or going out without an extra change of clothes nearby
• Hesitance exercising or doing things away from home
• Reduced self-esteem
• Avoiding sex due to a fear of leaking

There is also the risk of developing rashes and other uncomfortable skin conditions due to frequent exposure to urine, especially for those with severe incontinence who are hesitant to take necessary precautions to protect their skin.

The good news is that there are ways to manage this condition to reduce embarrassment, discomfort, and symptoms. By understanding what is stress urinary incontinence, how it is caused, and how to make certain lifestyle changes, it's possible to live without the fear of noticeable leakage and to reduce symptoms.

Causes of SUI

SUI is often caused by several changes to the body that may be out of your control. These all relate to the pelvic floor, which is primarily responsible for supporting both the bladder and urethra. When the pelvic floor does not function correctly, it can lead to SUI. Women commonly experience this after pregnancy and childbirth, when the pelvic floor becomes stretched. However, there are other causes and risk factors to keep in mind as well.

Weak Pelvic Muscles

When the pelvic muscles are weakened, the bladder neck can descend during stress or activity. This can lead to the urethra being unable to prevent a flow of urine. It can also be caused by the sphincter muscle in the pelvis weakening, allowing the urethra to leak because it can't stop the flow of urine.

Pregnancy and Childbirth

Pregnancy and childbirth put a major strain on women's bodies as ligaments and muscles stretch and relax to accommodate the growing baby. During childbirth, it's also possible to damage tissue and nerves in the pelvic floor and sphincter that can cause them to weaken and lead to stress incontinence.

Menopause and Hormonal Changes

Stress urinary incontinence can also develop during menopause due to hormonal fluctuations. As women age and approach menopause, their bodies stop producing as much estrogen. As estrogen levels drop during aging, the pelvic muscles can weaken, eventually resulting in SUI.

Other Medical Conditions

Other medical conditions can cause SUI, including:

• Obesity: Because excess body weight can increase abdominal pressure, those who are overweight or obese are at a higher risk for developing SUI.
• Age: As you age, your body changes and muscles can weaken. This can cause SUI.
• Pelvic surgery: People who have had pelvic surgeries may have symptoms of SUI due to damaged nerves, muscles, and supportive tissue. Women who have had hysterectomies and men who have received surgery for prostate cancer are at an increased risk of developing SUI due to weakening in the pelvic muscles.
• Pelvic prolapse: Women who have experienced pelvic prolapse, which occurs when the bladder, urethra, or rectum have slid into the vagina, may develop SUI due to nerve damage in the area.
• Nerve damage: Nerve injuries, especially in the lower back, can result in SUI. Women who have delivered a baby vaginally may also develop nerve damage that can contribute to this condition.

Symptoms of SUI

It's important to note that SUI does not have the same urgent need to urinate as is present with urge incontinence or overactive bladder. Those with SUI do not necessarily feel the urge to urinate before leaking. 

Unexpected Leakage of Urine With Physical Activity or Exertion

The primary symptom of stress urinary incontinence is the leakage of urine during activities that can increase abdominal pressure. The amount of leakage can vary from person to person, ranging from a few drops to releasing a gush or stream of urine.

Increased Frequency of Urination

People with SUI urinate or leak whenever activities put a strain on the abdomen, often resulting in much more frequent urination than someone who does not have incontinence. The frequency of urination may also increase for people with mixed incontinence, which is diagnosed when both urge incontinence and SUI symptoms are present.

Difficulty Controlling Urination

People with SUI cannot stop themselves from leaking or urinating when stress is exerted on their abdomens. This difficulty in controlling urination can occur both with and without a full bladder. Some people may also have difficulty controlling their urination if they are diagnosed with functional incontinence.

Diagnosis of SUI

Because there are several types of urinary incontinence, doctors must complete certain examinations to determine if someone has SUI or another condition. These checks often include physical exams, urologic evaluations, and urodynamic testing. During this process, you can expect your physician to ask you questions and evaluate your incontinence. You may also be requested to complete a bladder diary that will note how often you urinate, how much you urinate, and how much you drink, as well as details about any leakage and what you were doing when it occurred.

Physical Examination

To diagnose SUI, a doctor must first complete a physical exam. This will help to determine your anatomy, muscle strength, and pelvic support.

Urodynamic Testing

Urodynamic testing studies how the bladder and other parts of the urinary system, such as the urethra, retain and release urine. There are several types of testing, and your doctor will determine which will be the most suitable to diagnose your condition. These tests may include:

• Uroflowmetry: This test involves urinating into a testing device called a uroflowmeter that can measure the rate of urine flow to determine the strength of your bladder.
• Post-void residual measurement: This test involves measuring the amount of urine retained by the bladder after urinating, using an ultrasound or a catheter. 
• Cystometric study: A cystometric study, also known as cystometrics, involves inserting a small catheter with pressure sensors into the bladder and a second catheter into either the vagina or rectum to measure abdominal pressure. The bladder is then filled with water while you report how it feels. You may also be instructed to perform actions that typically cause you to experience leakage.
• Urethral closure testing: This test is often performed in tandem with cystometrics. It involves pulling on the catheter to determine the strength of the muscles around the urethra.
• Electromyography: This test uses sensors to record nerve and muscle activity in the pelvic floor, bladder, and urinary sphincters.
• Pressure flow study: After cystometrics, this test is used to determine how well the bladder can empty itself.
• Video urodynamic tests: Sometimes, X-rays and ultrasounds may be used to take images of the bladder to determine how it works. X-rays involve filling the bladder with contrast solution and ultrasounds involve filling the bladder with warm water before viewing it.

Urologic Evaluation

Urologic evaluation is the process of performing diagnostic testing on the urinary tract. It involves several common tests, including urodynamic testing. Other tests performed include:

• Blood analysis
• Urinalysis
• Urine cultures
• Imaging procedures

Seeking Medical Attention for Proper Diagnosis

When facing urinary leakage, seeking medical attention is the only way to attain a proper diagnosis. It can be embarrassing to discuss these issues with your physician, but they are there to help you to live a happy and healthy life. By speaking to your primary care physician, you can receive referrals to urologists who can help diagnose and treat your condition. Even if the amount of leakage is just a few drops, it's important to reach out to your doctor to begin treatment and find relief.

Treatment Options for SUI

Doctors often treat SUI with several approaches, such as lifestyle changes, medication, and medical procedures. Doctors look at individual diagnoses, causes, and symptoms when determining how to treat stress urinary incontinence.

Lifestyle Changes

Changing aspects of your lifestyle can help reduce the frequency of symptoms. These can range from pelvic floor exercises to working to reduce risk factors.

Pelvic Floor Exercises

Pelvic floor exercises can be completed anywhere. Kegel exercises are commonly used to help women with SUI strengthen their pelvic floor. Regular performance of these exercises can be effective at reducing leakage. Check with your medical team before incorporating Kegels into your treatment plan, as these exercises are not appropriate for everyone. 

Bladder Training

Bladder training involves creating a schedule for urinating often, which can reduce how frequently you leak. However, this should be monitored by a doctor.

Behavior Modification

One way to reduce symptoms is through behavior modification, which involves avoiding specific movements or activities that lead to leaking. This will not be possible for all activities that could potentially contribute to a leak, such as coughing, sneezing, laughing, and other involuntary reactions.

Reducing Risk Factors

Certain risk factors of SUI are within your control. By making necessary changes to reduce risks, symptoms can also be lessened in some cases. These include losing weight, managing a chronic cough linked to leakage, and quitting smoking.

Controlling Fluid Consumption

Your doctor may recommend that you avoid certain fluids, such as those with caffeine or alcohol. These fluids can irritate the bladder and lead to leakage. Likewise, using a fluid schedule can help manage symptoms by managing the amount of fluids available.

Medication

In the U.S., there is no FDA-approved medication treatment for SUI. Duloxetine is used outside of the U.S. However, some doctors may prescribe low doses of estrogen to be applied vaginally to reduce symptoms.

Medical Procedures

Sometimes, doctors recommend medical management for SUI symptoms, such as surgery or injections.

Vaginal Pessary

A pessary, commonly used when the bladder has prolapsed, supports the organ and reduces the frequency and intensity of leakage. This is a nonsurgical option; however, this removable device does require regular removal, cleaning, and refitting.

Urethral Inserts

Urethral inserts are small, disposable devices used to support the bladder and urethra to reduce leakage during times of heavy activity. These nonsurgical devices are inserted similarly to tampons and can be kept in place for up to eight hours per day.

Sling Procedure

This surgical option involves creating a sling out of synthetic material, your body's own tissues, or donor tissues. The sling is used to support the urethra to prevent leakage.

Injectable Bulking Agents

Injectable bulking agents are gels that are injected into tissue around the urethra, allowing the sphincter to close better to reduce symptoms.

Retropubic Colposuspension

During this treatment, a surgeon sutures ligaments along the pubic bone to reinforce the tissues that support the bladder and urethra.

Seeking Medical Advice for Appropriate Treatment

To make sure you get the right treatment for your unique case of SUI, it's important to speak to your doctor. Each case has its own unique causes and symptoms, so treatment for each person will vary. Your physician will be one of your biggest resources when managing your condition. Be honest with them about symptoms and frequency so they can help you come up with the best course of treatment.

Coping With SUI

Coping with SUI can help alleviate the emotional impact this condition can have and give you control of your life back. Even with treatment, it's likely there will still be urine leakage from time to time, and being prepared can help with coping.

Understanding and Accepting the Condition

Understand that this condition and the associated symptoms are not your fault. By accepting SUI for what it is and planning around it, you can alleviate some of the stress and embarrassment that often comes with it. Talking to your loved ones and planning around your condition can help. Always keep incontinence products and a change of clothes on hand, and when you're out and about, make sure you know where the restrooms are. 

Incorporating Lifestyle Changes for Management

If you have risk factors that exacerbate SUI, such as obesity or being a smoker, lifestyle changes can reduce symptoms. Your doctor can provide information on what you can do to help reduce symptoms and leakage.

Seeking Support From Friends and Family

Friends and family can offer social support for coping with and managing your condition. They may be able to help accommodate your SUI when you go out together and can help you feel better about yourself.

Incontinence Products

A common way many people with SUI manage their symptoms is by using incontinence products, such as those from Nexwear. These products can absorb urine as it leaks, wicking it away from the skin and protecting your clothing. 

Help to Manage SUI

Managing stress urinary incontinence with Nexwear products can help by keeping you dry, no matter where you are. By absorbing leaked urine, they give people with SUI the chance to go out without fear of an embarrassing leak. These products come in both pads and disposable underwear options and are discreet and form-fitting with odor-neutralizing features and soft materials to protect you when you need it the most.