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Stress Urinary Incontinence

Stress Urinary Incontinence (SUI) refers to the involuntary leaking of urine in response to physical stress and one of the most common forms of incontinence.

What is it?

In essence, stress urinary incontinence is caused by physical stress or pressure on the bladder within the abdomen. For example, laughing, coughing, sneezing and lifting all involve strong abdominal contractions that place significant pressure on the bladder. Running, changing directions quickly and jumping all involve higher impact and displacement of the bladder with similar results. Leaking occurs when the internal pressure generated overcomes the ability of the pelvic floor muscles to close off the urethra effectively.

What are the causes?

SUI is often caused by dysfunction of the pelvic floor muscles. However this doesn't simply mean that the muscles are weak. In fact, if the muscles are too tight, or being held in an already contracted position, they have a reduced ability to contract quickly and effectively and can still lead to leaking. (See blog post Too Long, Too Short or Just Right!)

However, the risk of incontinence is increased with some of these below factors:

  • Excessive straining with bowel movements or ongoing constipation

  • High impact activities or repetitive lifting without adequate pelvic floor strength and stability

  • Pregnancy - with the extra weight of a baby on your pelvic floor for the better part of 9 months!

  • Vaginal delivery with a long pushing phase >2hrs

  • Perineal tears with a vaginal delivery

  • Pelvic surgery

What can be done about it?

Prevention: Avoid constipation and ensure optimal strength of your pelvic floor ESPECIALLY if you are a runner, weight lifter or cross-fit enthusiast. Consult a pelvic health physio pre-natally to appropriately prepare your pelvic floor for pregnancy and delivery to minimise post-natal complications.

Pelvic Health Physiotherapy: Strengthening and optimising the function of your pelvic floor muscles is key to curing and preventing urinary incontinence. However, we now know that pelvic floor muscle dysfunction is the result of what is happening throughout the entire body. A physiotherapist can also assess the muscles to determine the cause of the dysfunction, whether it is simply due to weakness or if there is also spasm and tightness of the muscles preventing them from functioning optimally.

They are also able to assess the way that you move and even how you breathe to determine if your all-the-time biomechanics are contributing to poorly functioning muscles or excessive intra-abdominal pressure.

Pessary: A pessary is an insert that fits into the vagina and is most often used in the management of prolapse in conjunction with physiotherapy. However, they can also be beneficial in severe cases of SUI with a specific knob that helps to put external pressure on the urethra to stop leaking.

Surgery: The most common current procedure for SUI is Tension-Free Vaginal Tape (TVT) which helps provide extra support to the urethra under stress. As with any surgery, there are associated risks and should always be considered as the final option. It is not a guaranteed cure as every body responds differently and success is optimised by working with a pelvic health physiotherapist before and after the surgery.

Learn more about the other common form of incontinence - Urge Incontinence and Overactive Bladder.

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