Symptoms and Treatment Options for Stress Urinary Incontinence
Stress urinary incontinence (SUI) is characterized by involuntary leakage of urine during physical activities that increase abdominal pressure, such as coughing, sneezing, laughing, exercising, lifting, or changing positions. 1
Symptoms of Stress Urinary Incontinence
- Involuntary urine leakage that occurs with physical exertion, coughing, sneezing, laughing, or other activities that increase abdominal pressure 1
- Leakage typically occurs simultaneously with the activity that increases abdominal pressure 1
- Symptoms may range from slightly bothersome to debilitating, significantly impacting quality of life 1
- Prevalence varies widely, affecting approximately 25% of young women, 44-57% of middle-aged women, and up to 75% of elderly women 1
- Prevalence during sports activities can be particularly high, ranging from 0% in low-impact sports to 80% in high-impact activities like trampolining 2
Diagnostic Evaluation
Before initiating treatment, a proper diagnosis should include:
- Focused history to characterize the incontinence pattern, frequency, severity, and impact on quality of life 1
- Physical examination including pelvic examination 1
- Objective demonstration of stress urinary incontinence with a comfortably full bladder (cough stress test) 1, 3
- Assessment of urethral mobility 3
- Measurement of post-void residual urine volume 1, 3
- Urinalysis to rule out infection or other abnormalities 1, 3
Additional evaluation may be needed for patients with:
- Inability to make a definitive diagnosis based on symptoms and initial evaluation 1
- Concomitant overactive bladder symptoms or urgency-predominant mixed incontinence 1
- Known or suspected neurogenic lower urinary tract dysfunction 1
- High-grade pelvic organ prolapse 1
- Evidence of voiding dysfunction 1
Treatment Options
First-Line Conservative Management
Pelvic floor muscle training (PFMT) should be the first-line treatment for stress urinary incontinence, showing significant improvement in symptoms when provided with proper education and supervision. 1
- PFMT involves voluntary contraction of pelvic floor muscles (Kegel exercises) and has been shown to be effective with cure rates of 44-69% in the general population 1, 2
- Weight loss and exercise for obese women with SUI can significantly improve symptoms 1
- Bladder training and behavioral modifications may help reduce symptoms 1, 4
- Vaginal devices, pessaries, or urethral inserts can be used to prevent leakage during physical activities 2, 4
Pharmacological Options
- Currently, there is no single medication approved worldwide specifically for SUI 5
- Some off-label medications may be prescribed, though their efficacy is limited compared to other treatment options 5
- Estrogen is not indicated for the treatment of SUI 4
Surgical Options (Second-Line Treatment)
When conservative measures fail, surgical interventions may be considered:
- Midurethral slings (synthetic) are effective surgical options with high success rates (84% at 12-23 months) 1
- Single-incision slings are available, though long-term efficacy remains to be confirmed 1
- Urethral bulking agents can reduce leakage but effectiveness typically decreases after 1-2 years 1, 4
- Colposuspension (such as Burch procedure) and autologous fascial slings are established alternatives with robust evidence 1, 4
- For complicated and severe SUI, autologous fascial slings and artificial urinary sphincters are established treatments 1
Important Considerations and Caveats
- SUI must be differentiated from urgency urinary incontinence (UUI), which is characterized by involuntary leakage preceded by a sudden, compelling urge to urinate 1, 6
- Mixed urinary incontinence (MUI) combines features of both SUI and UUI, requiring careful evaluation to determine the predominant component 1, 6
- Concerns regarding mesh-related complications have led to decreased use of synthetic slings in some regions 1
- The transition from conservative to surgical management represents a significant increase in invasiveness and potential complications 1
- For women with uncomplicated SUI, extensive urodynamic testing may not be necessary before proceeding with treatment 3
- Surgical treatment should only be considered after conservative options have failed 3