Stress Urinary Incontinence

Stress urinary incontinence (SUI) is an inability to hold your urine whenever pressure is applied on your pelvic floor. This usually happens during certain physical activity or sudden movements. 

“Stress” is talking about too much physical pressure on the bladder or abdomen causing involuntary urine leakage. It is the most common type of incontinence that women experience, especially those who have given birth in the past. 

Essentially, SUI occurs when the intra-abdominal pressure exceeds the ability for our continence systems to maintain and leakage of urine occurs.

Bladder Anatomy

Let’s learn about the basic anatomy of the urinary system:

• Kidneys filter the blood and create urine

• Urethers (left and right) are tubes that transport urine from the kidneys to the bladder

• Bladder acts as a storage vessel for urine until it’s time to go to the toilet
  The bladder wall is muscular, called the Detrusor, that contracts to push urine out

• Urethra: release channel for urine to leave to bladder and exit the body
  The tubing is closed off by pelvic floor muscles and 2 different urethral sphincters

To hold urine in the bladder:

• The internal urethral sphincter and external urethral sphincter contract to create a stopper on the exit channel

• The bladder expands as urine comes into the bladder for ’storage’

• The deep and superficial layers of the pelvic floor muscles can contract to give the urethra more closing pressure and hold urine in the bladder

To expel urine from the body:

• The internal and external urethral sphincters relax

• The detrusor (bladder wall muscle) will contract to push the urine out the urethra

Stress urinary incontinence can occur if the urethral sphincters or pelvic floor muscles are weakened, it means you may be unable to contract them and hold the urine in the bladder. The bladder can also shift to a position if the pelvic floor muscles are weaker which may reduce the complete closure of the urethra. SUI can also be caused by over tightening of the pelvic floor and damage to the surrounding connective tissue supports.   

Symptoms of SUI

Accidental leakage of urine can range from a few drops to a full stream of urine depending on the severity or pressure experienced; it can occur from:

• Sneeze

• Jump

• Laugh

• Cough

• Standing up

• Lifting heavy object

• During sexual intercourse

• Exercise (burpee, squat)

Contributing Factors of SUI

Pregnancy and childbirth are strong contributing factors of SUI, this risk increases with multiple vaginal births. Other factors can include: respiratory conditions with chronic coughing, being overweight or obese, smoking, constipation, bladder or urethra disorders or long-term high impact activities. 

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Treatment Options for SUI

Physiotherapy is considered the first line of treatment for stress incontinence with up to 90% of women reporting significantly improved symptoms with an individualised program. 

A program may include:

• Pelvic floor muscle training, if that is required after a thorough assessment of your pelvic anatomy

• Bladder retraining

• Assessment of other contributing factors such as breathing or biomechanics of your pelvis, ribs and back

• Use of pessaries as an adjunct to the treatment

• Weight loss

• Teach The Knack