Stress Urinary Incontinence
Are you experiencing leaking of urine with coughing, sneezing, laughing, or high-impact activity? You are likely dealing with Stress Urinary Incontinence (SUI). SUI is one of the most common concerns that brings people to our practice. For many, SUI results in avoidance of certain activities that cause leakage and a reduced quality of life. The good news is that SUI is both preventable and highly treatable!
Although both men and women can experience SUI, it is far more common in women. The Urology Care Foundation estimates that at least one in three women will experience symptoms of SUI in their lifetimes. However common SUI may be, it is important to remember that “common” is not the same as “optimal”. There is no reason to accept this as ‘just part of life!’ The amount of urine leakage people experience with SUI can vary significantly from a few drops to a large amount that warrants use of protective padding or a change of clothes.
What Causes Stress Urinary Incontinence?
SUI typically occurs with increases in intra-abdominal pressure that occur when we do things like laugh, sneeze, cough, exercise, or lift. This increase in intra-abdominal pressure pushes down on the bladder. Ideally the pelvic muscles contract strongly enough to counter-balance this pressure and keep urine in the bladder. If the pelvic muscles are too weak, have too much tension, or are having trouble coordinating with the other muscles of our core, SUI can occur.
Pregnancy and delivery are common causes of stress urinary incontinence. As a pregnancy progresses, the weight of a growing baby can stretch and weaken the pelvic muscles and their support structures. This, in conjunction with the bladder being compressed by baby, increases the likelihood that SUI occurs. Stretching and weakening of the pelvic muscles can also occur with a vaginal delivery as the baby passes through the vaginal canal.
As previously mentioned, SUI is not limited to pregnancy. For men, prostate surgery is one of the most common causes of stress urinary incontinence. Since the prostate surrounds the urethra, its removal may result in a loss of support & strength in the urethra.
Normal aging can also contribute to SUI, as the hormonal changes make it more difficult to maintain muscle tone. Surgery (pelvic or prostate) may cause weakening of the pelvic muscles and lead to stress urinary incontinence. Another common contribution to pelvic muscle weakness is chronic constipation. Just like coughing and lifting, straining to evacuate the bowels also increases intra-abdominal pressure and, over time, can significantly weaken the pelvic muscles.
Finally, it is very important to note that too much tension of the pelvic muscles can also cause SUI! Many people hold too much tension in their pelvic muscles. Because these muscles must contract well to stop the urine from leaking, excessive tension can limit their ability to generate enough force to counteract an increase in intra-abdominal pressure.
The fact that SUI can be caused by either weakness or tension of the pelvic muscles is why it is critical to be examined by a trained pelvic therapist to determine the correct treatment approach for you. The treatment approach to solve SUI caused by weakness would be very different that the treatment for SUI caused by tension; doing Kegels is not always the right answer!
Other factors that contribute to SUI
- Smoking/ chronic cough– excessive coughing strains bladder and urethra
- Obesity – excess weight puts stress on bladder and urethra
- Medications -certain drugs may have side effects which increase the risk of SUI
How To Diagnose Stress Urinary Incontinence
If you are concerned about SUI, we strongly encourage you to seek out a trained pelvic floor therapist! Helping people resolve their SUI is our bread and butter. Many health care professionals such as primary care /family physicians, gynecologists, and urologists are familiar with pelvic rehab and may refer you, but you typically do not require a referral to see a pelvic PT – in most states you can contact a pelvic health physical therapist directly!
Pelvic health therapists’ expertise lies in the muscles, joints, and other tissues of the pelvis, and how they interact with the urinary, reproductive, and gastrointestinal systems. With your permission, an internal examination may be suggested to help determine how your muscles are communicating with each other as well as whether or not weakness, tension, or limited endurance is contributing to your SUI. This information helps your pelvic therapist determine the best tools and strategies to help you reach your goals.
SUI Treatment Options
It’s a common assumption that SUI is caused by pelvic muscle weakness and that the solution is to do ‘Kegels,’; while these may be helpful at some point, addressing SUI is much more complicated than this! Doing strengthening exercises if you have a tension issue could make your concerns worse (and even cause new ones!). It is important to have a thorough evaluation by a pelvic therapist, who will then develop a plan for you depending on whether your SUI is primarily caused by neuromuscular control issues, tension, and/or weakness. They will utilize a combination of strategies to help you resolve your concerns.
Non-Invasive Treatment Options
Pelvic Muscle Downtraining
Pelvic muscle down training is similar to the Kegel, but with pelvic muscle downtraining, the emphasis is placed on learning to lengthen the pelvic muscles. This not only reduces tension in the muscles to improve their ability to contract, it also improves our awareness of the pelvic muscles and the things that may be causing us to hold more tension in our pelvic floor.
Pelvic Muscle Training
If your SUI is primarily caused by weakness, pelvic muscle training exercises will likely be part of your treatment plan. While Kegels are often prescribed, there are many different exercises that target the pelvic muscles and can be performed to strengthen them to prevent leakage. In addition, it is important to have a strengthening plan specific for your body. Just like someone completely new to exercise would have a different routine at the gym than a a seasoned athlete, there is not a one-size-fits-all pelvic strengthening program! Your therapist will develop a program that is specific to your goals and to your pelvic muscles’ current strength and endurance.
Behavioral Therapy
As mentioned, many of our daily activities such as coughing, sneezing, lifting, and exercise cause increases in intra-abdominal pressure; it is this increased pressure that typically results in urine leakage with SUI. Your pelvic therapist will teach you strategies for anticipating and managing increases in intra-abdominal pressure to reduce or prevent leaking.
Additionally, we will work to optimize your bladder and bowel habits. Believe it or not, constipation can contribute to SUI because it crowds the bladder! Ensuring that you have optimal fluid intake – not too much and not too little – is important. Your pelvic therapist will also analyze your breathing mechanics and posture to address other issue that might be contributing to your SUI.
Coupled with pelvic and other muscle strengthening, behavioral therapy is an important part of treatment because if often addresses many of the contributing factors mentioned above and is what will prevent or resolve SUI for the longterm.
Medication
Currently, there are currently no FDA-approved medications that directly treat SUI. In some instances, certain drugs used to treat other conditions may be effective in treating SUI alongside other treatment courses. In pelvic therapy, our goal is to help you resolve your issues without needing to consider medications or surgery.
Surgical Treatment Options
Although pelvic therapy is usually highly effective in significantly reducing or completely resolving SUI, some patients choose to explore surgical options. Typically these procedures involve supporting the bladder or urethra. However, surgical procedures can carry their own set of risks and should be used only when necessary. In pelvic health, we typically encourage patients to try pelvic therapy prior to surgery. For those that do undergo surgical intervention, pelvic therapy is valuable both before and after surgery to ensure maximum healing and optimal results.
A urologist may also decide that direct collagen injections to the supportive tissues of your urethra are your best option. This is another way to provide support to the area and is the least invasive surgical procedure.
However, as mentioned above pelvic physical therapy is very effective in reducing or eliminating these symptoms, and we strongly encourage you to try this first before considering medication or surgery!
- RELATED: Post-Surgical Rehabilitation
Conclusion: Stress Urinary Incontinence
Stress urinary incontinence is a common yet complex concern that is unique to every individual. If you are experiencing SUI, we encourage you to schedule an in-person or Telehealth visit with a trained pelvic therapist to determine what treatment options are best suited to your symptoms. Although it can be distressing, SUI responds very well to pelvic therapy and it is very likely you will be delighted with your results!
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