If everyday activities like coughing, sneezing, laughing, lifting or exercising are causing urine leakage, you're not alone. Stress urinary incontinence (SUI) — the unintentional loss of urine during physical activity—affects up to one in three women over age 45.
It can feel frustrating, embarrassing and limiting. But stress urinary incontinence is highly treatable. With today's urinary leakage treatment options, many patients regain bladder control, confidence and the freedom to stay active.
Urogynecologist Dr. Dima Ezzedine, MD, at Tufts Medical Center, wants patients to know they don't have to live with symptoms.
"Urinary leakage is not something patients have to accept. After a thorough evaluation, we can recommend effective treatments that fit each person's lifestyle and goals," says Dr. Ezzedine.
What is stress urinary incontinence?
"Urinary leakage is not something patients have to live with. After a proper evaluation, we can identify effective treatments that fit each patient's lifestyle and goals," says Dr. Ezzedine.
Below are five of the most common treatment options.
Behavioral and lifestyle changes
Behavioral changes are often the first step in managing stress urinary incontinence and are commonly combined with other treatments.
These may include:
- Moderating fluid intake during the day
- Urinating on a scheduled basis
- Avoiding high-impact activities such as jumping or running
- Maintaining a healthy weight
- Avoiding foods and beverages that may irritate the bladder
For patients with mild symptoms, these strategies alone may significantly reduce leakage.
Pelvic floor muscle training
Pelvic floor muscle training, often called Kegel exercises, strengthens the muscles that support the bladder and urethra.
When performed correctly and consistently, these exercises can:
- Improve bladder control
- Reduce urine leakage
- Prevent symptoms from worsening
Many patients benefit from working with a pelvic floor physical therapist and specialized pelvic floor rehabilitation services as part of a comprehensive approach to care.
Vaginal pessary
A vaginal pessary is a removable silicone device placed in the vagina to help support the bladder and urethra and reduce leakage.
Pessaries:
- Are non-surgical and low risk
- Can be worn daily or only during physical activity
- Allow normal urination
This option is often used by patients who want a conservative treatment or who wish to delay or avoid surgery and are comfortable managing a device placed in the vagina.
Urethral bulking agents Urethral bulking is a minimally invasive procedure in which a substance is injected into the urethral wall to help it close more effectively to prevent leakage during physical activity.
Benefits include:
- Office-based treatment
- No incisions
- Minimal recovery time
While results may not be permanent, the procedure can significantly reduce symptoms and may be repeated if needed.
Surgical treatment options
Surgery may be recommended when conservative treatments don't provide adequate relief or are not desired. Surgical approaches are highly effective for many patients with stress urinary incontinence.
Common options include:
- Sling procedure: The most common surgery for stress urinary incontinence. A supportive sling is placed under the urethra to provide long-term effect and prevent leakage with activity. This is typically an outpatient procedure.
- Retropubic colposuspension: Sutures are used to lift and support tissue near the bladder and urethra. This option may be appropriate in select cases. Our urogynecologists will help determine the most appropriate surgical approach based on your symptoms and overall health.
Frequently asked questions about stress urinary incontinence
Is stress urinary incontinence a normal part of aging?
No. While stress urinary incontinence becomes more common with age, it is not inevitable and should not be ignored. Effective treatments are available at every stage of life.
What causes stress urinary incontinence?
Stress urinary incontinence is often caused by weakened pelvic floor muscles and ligaments or changes in the support of the bladder and urethra. Pregnancy, childbirth, weight gain and aging can all contribute.
Can stress urinary incontinence be treated without surgery?
Yes. Many patients experience improvement with lifestyle changes, pelvic floor therapy, pessary or urethral bulking injections without the need for surgery.
How do I know which treatment is right for me?
The best treatment depends on symptom severity, medical history and personal preferences. Your care team can help create a personalized care plan.
When should you seek care for urinary leakage?
If urine leakage is interfering with your daily activities, exercise routine or confidence, it's time to talk with a clinician. Stress urinary incontinence does not have to be part of aging—and it rarely improves on its own.
The earlier you seek an evaluation, the more treatment options you may have.
The bottom line
If stress urinary incontinence is affecting your daily activities, exercise routine or confidence, it may be time to see a specialist.
Tufts Medicine connects patients to experienced urogynecologists and urologists who provide personalized evaluations and evidence-based treatment.
