Stress urinary incontinence
What is stress urinary incontinence?
Stress urinary incontinence (SUI) is characterised by leakage with coughing, sneezing, laughing or exercise. The amount often depends on how much is in the bladder.
Sometimes it can be intermittent, and may be worse when you are tired or run-down. In some respects it can be more ‘predictable’ and therefore a little easier to manage, but for some it happens all the time and leads to a big reduction in exercise and activity.
It often occurs during and immediately after pregnancy; many will improve in the first few months after having a baby, but not all.
Exactly what occurs during vaginal delivery isn’t entirely clear but there may be damage to fine supporting ligaments and areas of muscle that support the urethra (the tube that drains urine from the bladder to the outside) and the back of the pubic bone.
It is probably the more common type of incontinence in younger women. Some women will still get SUI even if they have an elective caesarean section, although overall it is more likely if the delivery is vaginal.
In many cases, strengthening the pelvic floor can make a big difference – up to 70% of women report improvements with physiotherapy. However, it is likely this is only sustained as long as the exercises are done.
In addition, you may have injuries to your pelvic floor muscles, or rarely the nerves that supply the muscles, and find pelvic exercises of little or no benefit.
It is hard to predict who definitely won’t get any improvements, so physio is generally worth a trial as it has almost no risk. Sometimes a support pessary can be tried as well, especially if the symptoms only occur with exercise and if you are not ready to commit to surgery (eg if you are planning more children).
If this is not successful, there are surgical procedures.
Bladder function testing
Generally, unless the symptoms are very clear, some testing of bladder function may be required before moving to surgery. The test is called ‘urodynamics’ and is performed by a urologist.
Further information about this and a referral would be given and discussed at the time of booking. The testing helps predict the right type of surgical procedure, as well as ruling out problems with bladder emptying that can complicate the recovery, and picks up the odd patient where the issue is actually due to bladder muscle overactivity and where surgery may make the patient worse!
Usually a thin mesh ‘tape’ is placed under the urethra to provide a ‘hammock’ of support, so that when pressure suddenly rises in the abdomen the urethra gets compressed and closes off. The amount of mesh used is quite small, and in many studies around 90% of women notice a big improvement. It is often able to be done as day surgery, with just a few dissolving sutures at the end.
However, mesh can cause complications, and in the case of tapes for incontinence this depends a little on where the tape goes. Usually we place a tape into the groin, and sometimes this can lead to thigh pain, especially with walking.
Another option is to go up behind the pubic bone, although that can lead to bladder or very rarely bowel damage, and a newer option is to attach the mesh tape directly to the muscles of the pelvis. This has the advantage of minimising the amount of mesh used, but MAY not be suitable for all women, especially if the incontinence is severe or the woman has risk factors such as being overweight, or having a chronic cough.
All tapes can cause problems with pain with sex, pain with activity, and exposure of the mesh within the vagina. In some cases, even surgical removal of the tape may not cure all issues.