What is Stress Urinary Incontinence (SUI)?

Symptoms

What Are the Signs & Symptoms of SUI?

The key symptom of SUI is when urine leaks out during any activity that increases abdominal pressure. The amount can be a few drops to tablespoons or more. If you have mild SUI, you will leak during forceful activities such as exercise. You may also leak when you sneeze, laugh, cough or lift something heavy. If your SUI is moderate or more severe, you may also leak when you do less strenuous activities, like standing up or bending over.

These symptoms are different from urge incontinence or overactive bladder (OAB). With OAB, you feel an urgent and uncontrollable need to urinate. This "urgent" feeling could happen quite often. Leaks may involve a large amount of urine. For more information about OAB, visit our OAB web page

How Can SUI Affect my Life?

Many people find that SUI gets in the way of daily and social activities. It can affect family and sexual relationships. Some people even begin to feel isolated and hopeless because of it.

You may be embarrassed about this problem. You may not want to talk about it with a loved one or even a doctor. Please know that your primary care practitioner or a specialist can help.

Ask yourself whether leaking urine or the fear of leaking urine has:

  • Stopped you from doing things outside of your home?
  • Caused you to be afraid to be too far from a bathroom or a change of clothes?
  • Stopped you from exercising or playing sports?
  • Changed the way you live because you're afraid of leaks?
  • Made you uncomfortable with yourself and your body?
  • Changed your relationships with friends or family?
  • Made you avoid sex because you are worried that you will leak urine and be embarrassed?

If you answer yes to some of these questions, you should know that things can change for the better. There are many ways to manage and treat SUI.

Causes

What Causes SUI?

Front view of bladder.  Weak pelvic muscles allow urine leakage (left).  Strong pelvic muscles keep the urethra closed (right).
Front view of bladder. Weak pelvic muscles allow urine leakage (left).
Strong pelvic muscles keep the urethra closed (right).
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

The pelvic floor supports the bladder and urethra. If this area gets stretched, weakened or damaged, then SUI can happen. Pregnancy and childbirth can cause this. Chronic coughing or nerve injuries to the lower back or pelvic surgery (like surgery for prostate cancer) can also weaken the muscles.

What increases my risk of getting SUI?

SUI impacts older women most often, however, it is not caused simply by aging or by being female. It happens in younger women and some men too. For some young women, it can result from childbirth, and then improve after time. 

Risk factors for SUI include:

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

Diagnosis

How is SUI Diagnosed?

How do I talk about SUI with my Healthcare Provider?

The first step in diagnosing SUI is to talk to your healthcare provider about your symptoms. If you think you have SUI, tell your provider about what's happening. That is the only way to know for sure and find relief. Start with a Primary Care provider who can often initiate treatment without sending you to a specialist. If needed, they can refer you to a urologist or gynecologist. These are doctors who have more experience with pelvic floor conditions like urinary incontinence. Some may have obtained additional certification in female pelvic medicine and reconstructive surgery (FPMRS).

If you don't feel comfortable talking about your symptoms, a little planning will make you more confident. Here are some tips to help begin a conversation with your provider to get help:

Be Prepared

Before your visit write down your experiences and questions and bring this with you. Your notes will help you remember what you want to say. Make lists of:

  • Your symptoms, how they affect you, and how often
  • Prescription drugs, over-the-counter-medicines, vitamins and/or herbs you take
  • Past and current illnesses, surgeries or injuries
  • Questions you want to ask

Bring up the Topic

If your healthcare provider doesn't ask you about SUI symptoms, bring up the topic. Don't wait until the end of your visit. Talk about it early on. That way there will be time for questions. If a nurse meets with you first, tell the nurse about your symptoms.

Speak Freely and Ask Questions

Tell your healthcare provider about your symptoms and feelings. Talk about how your life is affected. Your provider is used to hearing about all kinds of problems. It's okay to talk freely.

Some people find it helpful to use questions like these to help begin the conversation:

  • I am afraid to be too far from a bathroom or change of clothes because of leaking. What can I do to manage this problem better?
  • I've changed my daily habits because I am afraid of "accidents". What can I do to get my life back?
  • I have stopped exercising or playing sports because I leak urine. Can you help me get back to doing the things I enjoy?
  • I have become uncomfortable with myself and my body because I leak urine. What can I do to regain control? 
  • I avoid having sex because I am worried that I may leak. Please help me learn some strategies to help with this.

Talk About Next Steps

When you speak with someone who can address your concerns, it helps to write down what you want to ask in advance. Bring your list with you to your visit. You may also want to begin a bladder diary. The bladder diary is a tool to track urinary patterns. With it, you write down when you urinate and leak, what might trigger problems, and eating /drinking patterns for a few days. Bring the diary with you to your appointment. You and your healthcare provider will go over it together.

Next, your healthcare provider will begin an evaluation to learn what's causing the problem. Below are some things healthcare providers may do to find the cause of SUI:

Your Medical History

Your healthcare provider will ask about your symptoms, how long you've had them, and how they're affecting you. A medical history will include questions about:

  • Your past and present health 
  • The frequency, timing and severity of your symptoms
  • Pain or other symptoms (like bloating or constipation)
  • Your diet
  • How much and what kinds of liquids you drink daily
  • For women: your menopausal status and childbirth history Delete bullet
  • Your past surgeries (especially if you had pelvic surgeries)
  • Over-the-counter and prescription drugs you usually take

Your healthcare provider is there to help you, don't be embarrassed talking about this topic. Speak honestly. This information will guide the best way to treat your problem.

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 genitalia and abdomen, prostate and rectum. Your healthcare provider may also test how strong your pelvic floor muscles and sphincter muscles are. You may be asked to squeeze your pelvic muscles and sphincter muscles for a Kegel test.

The physician may have you perform maneuvers such as coughing, straining down or stepping to see if these actions cause you to leak urine.

Bladder Diary

It is a good idea to start and keep a "bladder diary." This is a tool to track your day-to-day symptoms. In your diary, you will write down 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 running, coughing or sneezing.

The symptoms you share will help your provider understand what's happening so he/she can begin to diagnose and provide treatment for you.

Pad Test

There are two types of urinary pad tests: the one- hour test and the 24-hour test. The one-hour pad test is usually done in the office to learn about leakage with exercise or movement. The pad is removed and weighed afterwards to evaluate the amount of urine leaked. The 24-hour urine pad test is usually done at home for a complete day and night's evaluation. 

Other Testing

Sometimes the description of symptoms and physical exam do not provide enough information for an accurate diagnosis. When this is the case, you may be referred to a specialist for more comprehensive testing.

These specialized tests may be used for your diagnosis:

  • A urinalysis or urine sample to test for a urinary tract infection or blood in the urine. 
  • A bladder scan after urinating to show how much urine stays in your bladder after you urinate. 
  • A Cystoscopy uses a narrow tube with a tiny camera to see into the bladder to rule out more serious problems.
  • Urodynamic studies (UDS) are done to test how well the bladder, sphincters and urethra hold and release urine.

Once your provider understands the type of incontinence you have and rules out other conditions, he/she will offer you treatment options to feel better. 

Treatment

How is SUI Treated?

You and your healthcare provider can talk about ways to treat or manage your SUI symptoms. Your provider should explain the benefits and risks of each option to help you decide what will work best for you. Remember that not every treatment works for everyone, and you may have to try more than one to find relief.

SUI treatment options:

There are currently no drugs approved in the U.S. to treat SUI. Sometimes if you have SUI and OAB (Mixed Incontinence), your health care provider may prescribe OAB drugs or OAB treatments. These drugs may help reduce leaks for an overactive bladder. They do not treat SUI.

After Treatment

After Surgery for SUI

The goal of any treatment for incontinence is to improve your quality of life. Surgical treatments usually work, especially when combined with lifestyle changes. Make sure you rest for a few weeks to allow for recovery and healing.

Common sense and care will help the benefits of these surgeries last for a long time. Continue with daily Kegel exercises to maintain pelvic muscle strength. Ideally, you should maintain a healthy weight. A large amount of weight gain or activities that strain your belly and pelvis can harm surgical repair over time.

Stay in touch with your healthcare provider/surgeon about follow-up care. Typically, you will be asked to visit your surgeon between six weeks and six months after surgery for a follow-up visit. Your bladder may also be tested to see how well its releasing urine and if urine remains in the bladder after going to the bathroom. If leaking symptoms remain or if you have any pain, let your surgeon know right away.

In most cases, great improvements and even the cure of all leaks are possible for people who choose SUI surgery Keep in mind that the medical devices implanted with surgery may need adjustments over time.

More Information

More Information

Frequently Asked Questions (FAQ)

It's Time to Talk About SUI Frequently Asked Questions

Questions to ask your healthcare provider when being diagnosed:

  • What is causing my urine leakage problem?
  • Do you think that I have SUI?
  • What have my test results showed?

Questions to ask your healthcare provider about non-surgical treatment:

  • What are my treatment choices, other than surgery?
  • Are there any risks to vaginal inserts?
  • Do you recommend one option for me over another?
  • Will non-surgical treatment be enough for me?

Questions to ask about surgery:

Surgery Choices

  • What are my surgery choices?
  • What surgery do you recommend for me and why?
  • How likely is each option going to cure or improve my leaks?
  • What are the risks of sling surgery?
  • How long will this treatment last?
  • For slings: what type of sling material is the best choice for me and why?
  • Is this surgery covered by my insurance?
  • How many of these surgeries have you done, and how many do you perform yearly?
  • What happens if I don't do this surgery now?

Pre-Surgery

  • Is any testing needed before surgery?
  • Can you explain the test results to me?
  • What kind of anesthesia will I need for this surgery?
  • Should I get a second opinion? Why or why not?

Post-Surgery

  • How will I feel right after my surgery? In the first week? From then on?
  • What is the recovery time?
  • Will I be limited in any way and for how long? Can I drive?
  • When can I go back to work?
  • What can I do to improve my quality of life now?