By Kristin Austria, NP-C
Given the high prevalence of stress urinary incontinence (SUI) in women, primary care physicians could help many patients by initiating conversations on the subject during annual exams.
SUI affects about a third of women at some point in their lifetimes, sometimes beginning as early as their 20s or 30s. By age 65 and older, half of all women struggle with the condition, which often has a significant negative impact on their quality of life.
Unfortunately, providers and patients tend to normalize SUI symptoms as an inevitable result of aging or bearing children. Patients tend to be embarrassed to bring up concerns on their own, leaving far too many cases unaddressed and untreated.
The most important message is that SUI is NOT normal. The condition is also separate from overactive bladder and urge incontinence, presenting with different symptoms and requiring its own treatment strategies.
Caused by weakness, stretching and/or damage to the pelvic floor muscles, SUI is characterized by urinary leakage during activities that increase abdominal pressure, particularly exercising, sneezing, laughing, coughing or lifting heavy objects. In severe cases, something as simple as standing up or bending over can trigger leaks.
Along with pregnancy, childbirth and aging, risk factors include obesity, smoking, chronic coughing or constipation, nerve injuries to the lower back, pelvic surgery and – for a much smaller number of male SUI patients – prostate surgery.
Many patients become afraid to exercise, socialize, have sexual intercourse, or venture anywhere far from a restroom, leading to feelings of isolation and depression.
While there is no medication for SUI, there are effective ways to reduce and control symptoms. Those include Kegel exercises to strengthen pelvic floor muscles, lifestyle changes, fixed urination schedules, absorbent pads and/or insertable vaginal devices, and surgery.
A referral to a pelvic floor physical therapist will teach patients how to do Kegels properly (advising a patient to learn themselves is not enough). Urologists can also provide advanced diagnostic tools, such as cystoscopy and urodynamics testing, and treatment guidance.
On the lifestyle front, patients can help themselves by losing excess weight; quitting smoking; preventing constipation with a high-fiber diet; drinking plenty of water; getting regular exercise; avoiding common bladder irritants such as coffee, soda and spicy or acidic foods; and not holding their urine for more than three or four hours at a time.
For some SUI patients, wearing absorbent pads during workouts or social outings is enough. Others opt to try over-the-counter or prescription vaginal devices, some available at drugstores, on Amazon, and other online marketplaces. Inserted like tampons, these disposable or reusable devices help reposition and support the urethra.
Finally, surgical interventions include the placement of a midurethral synthetic sling or other sling types to hold up pelvic floor muscles.
If providers don’t talk about SUI, patients may never access any of these treatments. We have a responsibility to bring this common medical condition out of the shadows. SUI is NOT normal.
Austria is Lead Advanced Practice Provider (APP) for Urology of Virginia, based at the Devine-Jordan Center for Reconstructive Surgery and Pelvic Health. urologyofva.net