Stress Urinary Incontinence

What is Stress Urinary Incontinence?

Stress Urinary Incontinence (SUI) is the involuntary leakage of urine during activities that increase abdominal pressure, such as coughing, sneezing, laughing, lifting, or exercising. SUI affects at least 10-20% of women, many of whom do not realize that there are simple, effective treatment options available.

SUI affects women's quality of life in many ways. Incontinence may limit social and personal relationships as well as physical activity.

How Does the Normal Bladder Work?

As urine fills the bladder, the bladder (detrusor) muscle relaxes and stretches to accommodate the fluid. When the bladder is filled to a certain level, an urge to pass urine is felt. The brain then signals the detrusor muscle to contract and the urethral sphincter to relax, allowing urine to be passed. The bladder usually needs to be emptied about 5-7 times per day and 1-2 times at night.

The urethra and bladder are supported by the pelvic floor muscles, which contract during coughing, sneezing, and exercise to prevent leakage. Weakness in the muscles or damage to bladder neck support can result in leakage.

Causes

• Pregnancy and vaginal birth — direct injury to the pelvic floor support structures
• Obesity, chronic cough, heavy lifting, and constipation — increased abdominal pressure that aggravates stress incontinence
• Genetic factors — inherited predisposition to weaker connective tissues
• Menopause — hormonal changes that affect tissue integrity

Diagnosis

Your physician will ask questions about activities that cause leakage and will examine you to assess for any related problems, such as prolapse. Diagnostic steps may include:

• Cough stress test: Your doctor may ask you to cough with a comfortably full bladder to observe leakage.
• Bladder diary: A record of how much you drink, how often you void, the volume passed each time, and how much leakage occurs.
• Urodynamic studies: Used selectively when the diagnosis is uncertain, symptoms are complex, bladder emptying is abnormal, or the result may change surgical planning.
• Ultrasound scan: To determine how much urine remains in the bladder after emptying and to identify other causes of symptoms.
• Urinalysis: To rule out urinary tract infection.

Non-Surgical Treatment

Conservative treatment is usually recommended as the initial approach:

• General lifestyle changes: Drink enough to pass urine 4-6 times per day (usually about 1.5-2 liters). Maintaining weight within a healthy range has been shown to reduce the severity of SUI. Avoiding constipation and quitting smoking can also help.
• Pelvic floor exercises: A supervised pelvic floor muscle training program is recommended first-line and can meaningfully improve symptoms. A pelvic floor physiotherapist can confirm technique and tailor the program.
• Continence devices: Vaginal devices that help control leakage, inserted prior to exercise or worn continuously.

Surgical Treatment Options

When conservative treatments have been tried and are insufficient, surgical options may be considered:

Midurethral Sling

A permanent synthetic polypropylene mesh tape is placed under the urethra to provide support during increases in abdominal pressure. Retropubic and transobturator routes are both established options with different risk profiles. Mesh exposure, pain, voiding difficulty, and the possibility that complete mesh removal may not be possible should be discussed before surgery.

Burch Colposuspension

A procedure using sutures to support the urethra without synthetic mesh. Recovery, effectiveness, and risks differ from sling surgery.

Autologous Fascial Sling

Uses the patient's own fascia from the abdomen or thigh. It avoids synthetic mesh but involves a tissue-harvest incision and has a different risk of postoperative voiding difficulty.

Urethral Bulking Injections

Material is injected around the urethra to improve closure. It is less invasive but generally less durable than sling or fascial surgery, and repeat treatment may be needed.

Choice of treatment depends on symptom burden, examination findings, prior surgery, future pregnancy plans, preference about mesh, and willingness to accept recovery time and procedure-specific risks.

Sources

Clinical content updated July 2026. Source: AUA/SUFU Guideline: Surgical Treatment of Female Stress Urinary Incontinence.

When to Seek Help

If urinary leakage is affecting your daily activities or quality of life, many effective treatment options are available. Dr. Kruger can provide a thorough evaluation and create a personalized treatment plan.