If your bladder leaks when you sneeze, cough, laugh or exercise, you could be suffering from stress urinary incontinence (SUI), a condition caused by weakness in muscles in and around the pelvic floor. Although extremely common among women, SUI “accidents” can feel like more than an awkward inconvenience.
Stress urinary incontinence occurs when movement or activity puts physical pressure on your abdomen. It is different from urge incontinence or overactive bladder, which might have you regularly rushing to find a restroom. But the two can be related. According to Jessica Karwoski, a urogynecology Nurse Practitioner with The Iowa Clinic, women with incontinence typically have a component of both types.
Talking with your doctor can help you move from feeling shame or frustration around symptoms to finding solutions and staying dry.
Is stress urinary incontinence serious?
“Incontinence, in general, is rarely dangerous to your health,” Jessica says. “However, it can be detrimental to your quality of life.”
Stress urinary incontinence might start with an occasional trickle or have you soaking through multiple pads or disposable underwear products each day. It might also cause you to stay away from working out or engaging in activities that bring you joy but that you fear could trigger leaks.
Jessica encourages patients who are feeling discouraged by SUI symptoms to explore treatment options. She'll start by identifying whether urge or stress is the primary form of incontinence and recommend the right method to get it under control.
“I see a lot of women that downplay or don't feel that the issue is big enough or bothersome to be treated,” Jessica says. “But you do have options, both surgical and nonsurgical.”
Who is most often impacted by stress urinary incontinence?
SUI is significantly more prevalent in women than men and according to Urology Care Foundation, about one in three women suffer from SUI at some point in their lives.
Pregnancy, which causes the pelvic floor to stretch and weaken, and whether you have had a vaginal childbirth, which can cause muscle damage in the pelvic area, increase the risk.
Other factors can include a history of radiation, or back or pelvic surgeries which can also impact the nerves of the bladder. Smoking can also contribute to SUI — partially because of the chronic cough associated with a longtime habit.
Connective tissue disorders such as Ehlers-Danlos syndrome are genetic influences that can cause stress urinary incontinence.
Muscle loss associated with advanced age Is a common factor, too. (About half of women aged 65 and older say they sometimes leak urine.)
What are some common treatments for stress urinary incontinence?
Several nonsurgical therapies can help treat stress urinary incontinence.
Jessica says she often starts by recommending pelvic floor exercises, known as Kegel exercises, for patients experiencing SUI. These exercises, which involve active contractions to strengthen the pelvic floor muscles, can be done at home and help control the flow of urine.
“For patients who need or want a little more guidance, we often refer them to pelvic floor physical therapists who can make sure that they are engaging the correct muscles and doing the exercises properly,” Jessica says.
If those exercises alone don't improve symptoms, she says another common nonsurgical option would be to fit a patient for a vaginal pessary. This soft, removable device supports areas that are affected by pressing against the wall of the vagina and the urethra. Pessaries are effective for 85-90% of women.
“If these conservative management options are not successful, we have other options that are longer lasting,” Jessica says. “There are bulking agents that are injected around the urethra that can last up to 5-7 years. The benefit of this procedure, is that there is not a long recovery period and patients can get back to work within 2 days.”
Another procedure, called the urethral sling, is an outpatient procedure that occurs under anesthesia and takes less than an hour. A sling is minimally invasive and has a 90% success rate.
Taking the next steps to stop SUI.
If SUI-related “accidents” are causing you to change your regular activities, or making you uncomfortable, it’s important to bring up the topic with your provider.
Before your appointment, it can help to track your fluid intake, how often you urinate, and the triggers for leaks (i.e. running, getting out of the car, coughing, etc.) for a week or so. This journal can help guide the conversation and pinpoint problems.
The sooner you address stress urinary incontinence, the sooner you can start to enjoy a leak-free life. Schedule an appointment today.
JessicaKarwoski , ARNP
Jessica Karwoski, ARNP joined The Iowa Clinic in 2022 because she wanted to be a part of a patient-centered facility that gives back to the community. Since she was five years old, she has known that healthcare was her passion. She chose urogynecology because she enjoys taking care of women and feels this area of medicine is an underserved specialty. Prior to joining the Clinic, Jessica served in the Air Force and has practiced medicine all over the country.
Outside of work, Jessica enjoys hiking, traveling, exercising, and spending time with her husband, two daughters, and two rescue dogs.