What is the cause of stress urinary incontinence (SUI) in a 28-year-old female, with onset after running 6 miles?

From the Guidelines

Stress incontinence in a 28-year-old female after running 6 miles is likely due to pelvic floor muscle weakness, and I strongly recommend starting with pelvic floor exercises (Kegels) as the first line of treatment, as supported by the most recent evidence 1. The diagnosis of stress urinary incontinence (SUI) involves a comprehensive assessment, including medical history, physical examination, and in some cases, invasive urodynamics 1. Pelvic floor muscle training emerges as a first-line management strategy, showing efficacy in symptom improvement when good educational instructions and supervision are provided 1. Some key points to consider when implementing pelvic floor exercises include:

• Performing Kegels 3 times daily with 10-15 repetitions each session
• Contracting the pelvic floor muscles for 5 seconds, then relaxing for 5 seconds, gradually increasing hold time to 10 seconds
• Using a bladder diary to track fluid intake and urination patterns
• Emptying the bladder before exercise and avoiding caffeine, alcohol, and excessive fluid intake before running to help reduce symptoms
• Considering a vaginal pessary or incontinence tampon for temporary support during exercise If symptoms persist after 6-8 weeks of consistent pelvic floor exercises, it is essential to consult with a healthcare provider for evaluation, as physical therapy with a specialist in pelvic floor rehabilitation is often beneficial 1. This condition occurs because high-impact activities like running create increased abdominal pressure that can exceed the strength of the pelvic floor muscles, especially if these muscles have been weakened, and it can occur in nulliparous women due to repetitive strain during high-impact activities 1. Surgical interventions, such as midurethral and single-incision slings, offer a second-line option, although concerns regarding mesh-related complications persist, and the long-term efficacy of single-incision slings remains to be confirmed 1. Urethral bulking agents, colposuspension, and autologous fascial slings are existing alternatives supported by robust evidence, albeit with a different adverse event profile 1. Management of complicated and severe SUI remains challenging, with autologous fascial sling and artificial urinary sphincters being established treatments, but high-quality data remain lacking 1.

From the Research

Stress Incontinence in a 28-Year-Old Female

Onset After Running 6 Miles

• Stress urinary incontinence (SUI) is a condition characterized by an involuntary loss of urine occurring as a result of an increase in intra-abdominal pressure due to effort or exertion, or on sneezing or coughing 2.
• The onset of SUI after running 6 miles suggests that physical activity may be a trigger for the condition in this individual.
• Estimates of the prevalence of SUI in the female population range from 10% to 40% 2.

Diagnosis and Treatment Options

• SUI can be diagnosed during physical examination and by using low-cost office diagnostics 3.
• Treatment options for SUI include observation, pelvic floor physical therapy, vaginal inserts, or continence pessaries, as well as procedural interventions such as urethral bulking agent injection, synthetic mesh midurethral sling placement, autologous fascial pubovaginal sling placement, or retropubic colposuspension 4.
• Pelvic floor muscle exercise (PFME) has been recommended as a first-line treatment for SUI, and has been shown to be effective in reducing symptoms and improving quality of life 5, 6.

Pelvic Floor Muscle Exercise (PFME)

• PFME involves exercising the pelvic floor muscles to improve strength, power, endurance, and relaxation, and can help to prevent urine leakage and suppress urgency 5.
• Studies have shown that PFME can be an effective treatment for SUI, with women who undergo PFME being more likely to report cure or improvement of symptoms compared to those who do not receive PFME 6.
• PFME has also been shown to reduce the number of leakage episodes and improve quality of life in women with SUI 6.

Surgical Treatment Options

• Surgical treatment options for SUI include midurethral slings, retropubic urethropexy, urethral bulking agents, and artificial sphincters 3.
• Synthetic mid-urethral slings are considered the gold standard for the surgical treatment of SUI, but other options may be considered depending on individual patient circumstances 2.
• The choice of surgical procedure depends on a variety of factors, including the severity of SUI, anatomy, medical and surgical comorbidities, and patient preferences 4.