The Female Pelvic Medicine

Stress Urinary Incontinence


SUI is the loss of urine that occurs during a physical exertion, pushing urine out of the bladder. Activities such as coughing, sneezing, laughing or exercise cause increased pressure in the bladder resulting in incontinence.

About SUI

SUI is extremely common, affecting 1 in 3 women over 45 years. SUI most commonly develops from changes that happen during pregnancy or childbirth, weakening the support to the urethra. Other causes are obesity, aging, chronic cough, smoking, heavy weight-lifting and genetics.

The normal bladder is a balloon-like sack of muscle which expands as urine flows into it. Sudden, unexpected pressure caused by “stress” activity pushes the urine out of the urethra, the tube that carries urine out of the body.

This unintentional leakage of urine can vary from mild to severe depending on the degree of the problem. Sometimes women limit their physical or social activity level to avoid leaking and embarrassment. SUI does not have to be tolerated, it is a very treatable condition!

SUI Diagnosis

Not all incontinence is due to SUI, there are other types of leakage. A description of when and how often you leak is helpful. You may be asked to keep a bladder diary to record the episodes.

A physical exam will also be performed to evaluate the type of leakage you are having. You may be asked to cough with a full bladder. Other tests that might be performed include:

    • Urine Analysis to check for infection or blood in the urine.
    • Ultrasound to evaluate how much urine remains in the bladder after emptying.
    • Urodynamics which provides more in depth information about how your bladder is functioning.

SUI Treatment

There are many treatment plans for SUI, the ideal one for you depends on your individual symptoms and the effect on your quality of life. Treatments range from lifestyle changes and exercises to surgical cures.

Lifestyle Changes

Lifestyle changes that can help improve SUI include:

    • Urinating on a schedule
    • Weight loss if necessary
    • Smoking cessation
    • Treatment for constipation or straining with bowel movements
    • Avoiding very heavy weightlifting

Vaginal Pessary

A pessary is a silicone device inserted into the vagina, similar to a diaphragm. You will need to be custom fit for a pessary, but with correct fit, the pessary pushes the urethra closed helping control urine outflow. It can be used all the time or only when needed such as during exercise.

A pessary still allows you to urinate normally when you need to.

Urethral Bulking Agents

SUI may be improved with the injection of a substance to “bulk up” the urethra. This treatment can be helpful if your urethral sphincter (the muscle surrounding it) is weakened. Your doctor will be able to evaluate if you are a candidate for this procedure. This procedure is usually done in the office and typically lasts for several to many months. Most women need 1-3 injections per year.

SUI Surgery

Surgery for SUI involved addressing the weakened supportive muscles and tissues surrounding the urethra. There are different surgeries for SUI including urethral suspensions and midurethral slings. Surgery is usually very successful and often low risk. However not all women are candidates for surgery.

Take Home Message

SUI is very common but not normal. It can be successfully treated so you can return to your normal, active life. There are conservative options that can help manage symptoms and several successful surgeries to treat SUI. Dr. Guerette will discuss each of these options with you and together you will determine which course of treatment is best for you.

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I put off seeing a doctor because I was embarrassed about my condition. Dr. Guerette put me at ease and, ultimately, he made me feel like a new woman.