Stress Urinary Incontinence - SUI

SUI is very common and one in three women will actually have SUI at some time in their lives.¹

^References:

1.       Urology Care Foundation, Stress Urinary Incontinence, the Official Foundation of the American Urological Association.

SUI is usually caused by the weakening of the pelvic floor muscles, which can happen naturally with aging or can be as a result of factors such as childbirth, obesity or a pelvic floor disorder.

MUI occurs in patients experiencing symptoms of both stress incontinence and urge incontinence (overactive bladder). Many of the same treatment options are available to MUI patients as SUI patients, but are often coupled with bladder training exercises and other overactive bladder treatments.

Whilst SUI can be managed at home with incontinence pads, a survey in 2019 showed that, of those wearing pads, 50% said that they made them feel more self-conscious, 72% said they were embarrassed to be wearing incontinence products, and a further 29% said it had led to a fear of going out in public. 

Therefore, we encourage all women to seek help with their SUI and speak with their GP, who will be able to refer you to specialist continence experts where a team of NHS doctors, nurses and physiotherapists can help diagnose and manage your SUI before considering other conservative treatments such as physiotherapy and injections for SUI.   

Going to see your GP is the first step for most people seeking treatment for their SUI., meaning it’s a common issue that GPs are used to dealing with.  

In order to diagnose you with SUI, your GP may ask some questions regarding your symptoms and ask you to complete a bladder diary. You can do this before seeing your GP which will help speed up the process of   diagnosing your condition.  A bladder diary and advice on how to complete it can be found here When keeping a bladder diary, you may document your fluid intake, how often you pass urine and how many times you leak. This will help the GP understand the severity of your SUI.

Treatment options for SUI include physiotherapy injection therapy and surgery and it’s not unusual to try multiple options on your treatment journey. It’s important to consider success rates as well as associated risks for each procedure carefully to decide which one is best for you. You can see a summary of this information for the major treatment options here.

Non-surgical treatments

·         Lifestyle changes: your doctor may suggest that you cut down on drinks that stimulate the production of urine such as caffeine and alcohol to reduce bladder leakage. Additionally, if you are overweight, losing weight may help relieve some of the pressure placed on the bladder and reduce symptoms.

·         Physiotherapy: pelvic floor exercises strengthen the muscles around the bladder that control urination and ultimately lead to better management of leakage.  

·         Urethral bulking: also known as injection therapy, a soft gel is injected at three of four points in the urethral wall, close to the neck of the bladder. This narrows the internal space of the urethra and allows it to stay closed, even when there is high pressure in the bladder. This procedure can usually be done in an outpatient setting and will not require a hospital stay. (Available both NHS and Private)

Surgical treatments

·         Colposuspension: A cut is made into the abdomen so the surgeon can place stitches in the pelvis to lift the bladder neck upwards to help prevent leakage from the bladder. This usually requires up to a two -five day stay in hospital. (Available both NHS and Private)

·         Mesh slings: A cut is made in your vaginal wall where a surgeon will insert a plastic mesh sling to support the bladder neck and prevent leakage from the bladder. Mesh slings are not currently available on the NHS due to a government review. This procedure can usually be done as day surgery. (Available both NHS and Private)

·         Autologous tissue slings: A piece of your own tissue is cut away, usually from your thigh or abdomen, and then used in place of the plastic mesh sling to support your urethra which is paced through the vaginal wall. This usually requires up to a two day stay in hospital.

If invasive surgery is not something you want to opt for initially, you can discuss other treatment options with your doctor as well as the results you want to achieve. It is important that you discuss the potential risks associated with each treatment option and how each may impact your quality of life with your doctor, as this will very likely play an important role in the treatment you choose. One UK study found that the majority of women (75%) would opt for a minor procedure with a low risk of complications as a first treatment.²

When you have a full picture of the treatment risks, complications, and expected results, you can make an informed decision with your doctor about what treatment is best for you.

 References :

1.       An online survey was conducted by Atomik Research among 2,001 women. The research fieldwork took place between the 21^st and the 27^th of August 2019. Atomik Research is an independent creative market research agency that employs MRS-certified researchers and abides to MRS code.

2.       Data analysed in Dwyer L et al., “Voice your choice”: a study of women’s choice of surgery for primary stress urinary incontinence. International Urogynaecology Journal (2020);31:769-777

A shared decision-making process is essential in ensuring a positive outcome when seeking treatment from your doctor. A physician may make a treatment recommendation based on your outcome goals, lifestyle, and SUI severity along with other factors, but ultimately, the decision about what treatment option you want to pursue is yours.