Nu-V  Stress Urinary Incontinence (SUI)  Treatment

What Is Stress Urinary Incontinence?

SUI is the involuntary release of urine due to sudden pressure on the bladder. This can occur during common activities such as sneezing, exercising, or bending over. Unlike urge incontinence, which is caused by an overactive bladder muscle leading to a sudden, intense need to urinate, SUI results from weakened pelvic floor muscles or damaged support tissues. Understanding this distinction is crucial for diagnosis and treatment.

The bladder is a muscular organ that stores urine, and the urethra is the tube that allows urine to exit the body. Normally, strong pelvic floor muscles help keep the urethra closed. When these muscles are weakened, even minor pressure changes can cause leakage. Contributing factors include aging, hormonal fluctuations, and the impact of childbirth.

Physiological Causes of SUI
Several physiological factors can lead to the development of SUI:

1. Weakened Pelvic Floor Muscles: Childbirth, pregnancy, and menopause can weaken the muscles that support the bladder.
2. Hormonal Changes: The decline in estrogen during menopause reduces the strength of pelvic tissues.
3. Childbirth and Trauma: Vaginal deliveries may damage pelvic tissues and nerves, causing immediate or delayed symptoms.
4. Surgical Procedures: Operations like hysterectomies or prostate surgeries can compromise pelvic floor integrity.

Risk Factors
Certain factors elevate the risk of developing SUI:

• Age: Muscle tone and tissue elasticity naturally decrease with age.
• Gender: Women, particularly those who have given birth or gone through menopause, are more susceptible.
• Pregnancy and Childbirth: Multiple pregnancies, especially vaginal births, heighten SUI risk.
• Obesity: Excess weight increases pressure on pelvic structures.
• Chronic Coughing: Conditions like asthma or smoking-related coughing strain the bladder.
• High-Impact Sports: Activities such as running can stress pelvic muscles over time.

Recognising SUI Symptoms and Diagnosis

Common Symptoms of SUI
Symptoms range in severity, but common triggers include:

• Coughing or Sneezing: Sudden pressure changes lead to leaks.
• Laughing: A hearty laugh may cause unintentional urine release.
• Exercise: High-impact workouts like running exacerbate abdominal pressure.
• Lifting Objects: Everyday activities, such as carrying groceries, may induce symptoms.
• Sexual Activity: Leakage during intimacy can be distressing and impact relationships.

Mild SUI may result in small leaks, while severe cases can lead to more significant, uncontrollable episodes. Seeking medical attention is vital when symptoms interfere with daily life.

Diagnosing Stress Urinary Incontinence
A precise diagnosis is crucial for effective treatment. At The Women’s Health Clinic, we use various methods:

1. Physical Examination: A pelvic exam assesses muscle strength and detects abnormalities.
2. Urinary Pad Test: Measures the volume of leaked urine by weighing absorbent pads before and after use.
3. Bladder Diary: Tracking fluid intake and leakage episodes over several days helps clarify symptoms.
4. Bladder Stress Test: Observes urine leakage during activities like coughing.
5. Urinalysis: Screens for infections or other issues.
6. Urodynamic Testing: Analyzes bladder function and pressure.
7. Cystoscopy: Uses a camera to inspect the bladder and urethra.

These diagnostic tools guide personalized treatment plans.

 Non-Surgical Treatment Options for SUI

Lifestyle Modifications
Initial treatment often involves lifestyle changes:

• Weight Management: Losing weight alleviates pressure on pelvic structures.
• Quit Smoking: Reducing chronic coughing helps prevent bladder strain.
• Dietary Changes: Avoid bladder irritants like caffeine and alcohol. Increase fiber intake to minimize constipation.
• Stay Active: Engage in low-impact exercises to maintain health without straining the pelvic floor.

Pelvic Floor Exercises (Kegels)
Kegel exercises strengthen pelvic muscles and are highly effective. Here’s how to do them:

1. Identify Muscles: The ones used to stop urine flow are your pelvic floor muscles.
2. Perform Kegels: Squeeze and hold these muscles for three seconds, then relax for three. Repeat 10-15 times, three times daily.
3. Stay Consistent: Most see results within a few months with regular practice.

Biofeedback and Physical Therapy
For those who struggle with Kegels, biofeedback and physical therapy can help. Sensors measure muscle activity, ensuring proper engagement during exercises.

Bladder Training Techniques
Gradually increase the time between bathroom visits to improve bladder control:

• Scheduled Breaks: Start by visiting the restroom every two hours, then gradually extend intervals.
• Delay Urination: Hold your bladder for a few extra minutes, gradually increasing duration.
• Smart Hydration: Drink fluids in moderation and avoid large volumes at once.

Medical and Minimally Invasive Treatment Options

Pessaries and Medical Devices
When lifestyle changes are insufficient, medical devices like pessaries can help:

• Pessaries: Custom-fitted devices inserted into the vagina to support the bladder. They are removable and ideal for those not pursuing surgery.
• Urethral Inserts: Temporary, disposable devices used during high-impact activities.
• External Urethral Devices: Rarely used but can be effective in select cases.

Consulting a specialist ensures optimal device fitting and effectiveness.

Laser Therapy: Nu-V
A non-invasive option, Nu-V uses laser technology to tighten tissues around the bladder:

• Benefits: No incisions, minimal downtime, and no anesthesia required.
• Procedure: Typically requires two sessions spaced a month apart, with little discomfort reported.

Medications and Topical Treatments

• Topical Estrogen: Helps strengthen pelvic tissues in postmenopausal women.
• Other med: An antidepressant that also increases urethral muscle tone but may have side effects.

Combining these therapies often yields the best results.

Surgical Options for Severe SUI

When non-surgical methods are inadequate, surgical intervention may be necessary.

Surgical Procedures

1. Midurethral Sling Procedures: Synthetic or natural tissue slings support the urethra.
   • TVT and TOT: Minimally invasive, quick recovery, but potential for mesh complications.
2. Bladder Neck Suspension: Secures the bladder neck, effective but with a longer recovery.
3. Bulking Agents: Injections offer temporary relief but require ongoing treatments.
4. Artificial Urinary Sphincter: A device for severe cases, mostly in men, with a risk of mechanical failure.

Prevention Strategies for SUI

Healthy Lifestyle Choices

• Maintain a Healthy Weight: Reduces pelvic pressure.
• Quit Smoking: Prevents chronic cough and protects pelvic muscles.
• Exercise Safely: Focus on low-impact activities to avoid straining pelvic muscles.

Pelvic Floor Exercises for Prevention

• Perform Kegels regularly to strengthen pelvic muscles.
• Consistent practice can prevent or minimize SUI symptoms.

Avoid Bladder Irritants
Reduce intake of caffeine, alcohol, and acidic foods.

Hydration Tips
Stay hydrated but avoid drinking large amounts at once.

Living with SUI: Coping Strategies and Support

Emotional Impact and Support
SUI can lead to embarrassment and anxiety, but it’s important to recognize that it’s a common medical issue. Support groups and therapy can offer emotional relief.

Incontinence Products
Modern products are discreet and effective, helping manage symptoms confidently.

Stay Active and Engaged
Choose activities like swimming or yoga to maintain fitness without exacerbating symptoms.

Professional Counseling
Seek counseling if SUI affects your mental health.

The Future of SUI Treatment

Emerging Therapies

• Stem Cell Therapy: Aims to naturally regenerate pelvic muscles.
• Advanced Mesh Materials: Reduce risks associated with traditional sling procedures.
• Robotic Surgery: Offers precision and quicker recovery.

Non-Surgical Innovations

• Magnetic Stimulation Therapy: Strengthens muscles through magnetic pulses.
• Wearable Technology: Provides real-time feedback for pelvic exercises.

Ongoing Research
Clinical trials continue to explore groundbreaking treatments, from hormone therapies to biocompatible surgical materials.