Stress Urinary Incontinence (SUI)

SUI is the most common type of urine leak. It happens when activities like laughing or coughing cause urine to leak.

Key statistics

About 1 in 3 women have SUI at some time in their life (33% in women < 60 years; 50% in women > 65 years).
SUI is less common in men. For most men who have SUI, it is caused by prostate cancer surgery, injury or nerve damage.

What Happens Normally?

Your pelvic floor muscles hold your bladder in place. When you are ready to urinate, the brain signals your bladder muscles to squeeze.

What are the Signs & Symptoms of SUI?

The key symptom of SUI is when urine leaks out during activity. You may leak when you exercise, sneeze, laugh, cough or lift something. You may also leak when you stand up, walk or bend over.

What Causes SUI?

SUI happens when your pelvic floor muscles are stretched, weak or damaged. The pelvic floor muscles support the bladder and urethra. If they become weak (childbirth, pelvic surgery), the muscles may not hold in urine.

What increases my risk of getting SUI?

Risk factors for SUI include:

  • Gender: females are more likely to get SUI
  • Pregnancy and childbirth
  • Nerve injuries to the lower back
  • Pelvic or prostate surgery
  • Smoking
  • Chronic Coughing 

How is SUI Diagnosed?

Your Medical History

  • Your past and present health problems
  • Over-the-Counter and prescription drugs you usually take
  • Your diet
  • How much and what kinds of liquids you drink daily

The Physical Exam

For women, your physical exam may include checking your abdomen, the organs in your pelvis, and your rectum. For men, a physical exam may include checking your abdomen, prostate and rectum.

Pad Test

You might be asked to wear a pad while doing an activity or exercising. The pad is then weighed to learn how much you leak during physical activity.

Bladder Diary

This can keep track of your day-to-day symptoms. You will record what fluids you drink and how often you go to the bathroom. You also need to note when you have leaks. Include what you were doing when the leak happened, such as exercising, coughing or sneezing.

Other Testing

  • A urine sample to test for infection or blood
  • A bladder scan (ultrasound of your bladder) to show how much urine stays in your bladder after you urinate
  • Urodynamic testing to see how well your lower urinary tract store and release urine
  • A cytoscopy where a narrow tube with a tiny camera is used to see into the bladder to rule out problems

How is SUI Treated?

  • Conservative therapy
    • Absorbent pads
    • Pelvic floor/Kegel exercises
    • Dietary changes
    • Bladder training/bladder diary
    • Vaginal tampons or pessaries
  • Surgical Therapy

(1) Urethral bulking injections

  • – Used for men or women
  • Strengthens the muscle valve to keep the bladder closed

(2) Urethral slings

  • – Used for men or women with mild SUI
  • A mesh material is placed under your urethra to provide support

(3) Bladder neck suspension

  • Used for women; the bladder is secured to the pubic bone for support

(4) Artificial urinary sphincter

  • Used for men with severe SUI
  • Insertion of a fluid-filled cuff around the urethra, a pressure-regulating balloon into your belly, and a pump within your scrotum