Stress Urinary Incontinence (SUI)

What is Stress Urinary Incontinence (SUI)?

Stress urinary incontinence (SUI) is the leakage of urine during physical activities, such as exercising, coughing, laughing, or sneezing. It occurs when muscles and tissues supporting the bladder and urethra weaken. Causes include pregnancy, childbirth, or aging, leading to a weakened sphincter muscle that struggles to control urine flow.

Non-Surgical Treatment Options

Before considering surgery, your healthcare provider may recommend nonsurgical treatments, including:

• Lifestyle changes: Reducing fluid intake, avoiding caffeine, stopping smoking, and losing weight can decrease leakage.
• Pelvic muscle exercises (Kegels): Strengthen pelvic floor muscles to improve bladder control.
• Physical therapy: Specialized exercises or biofeedback to strengthen pelvic muscles.
• Pessary: A device inserted into the vagina to support the bladder and reduce leakage.
• Over-the-counter devices: Similar to a tampon, these are inserted into the vagina to provide support.

If these methods do not relieve symptoms, surgery may be an option.

Surgical Treatment Options

Several surgical methods help improve SUI in most women:

1. Urethral Injections: Synthetic materials are injected around the urethra to tighten the opening and provide support. This office procedure typically takes less than 20 minutes and may require multiple injections for best results. Injections help reduce symptoms but may not completely stop leakage.
2. Midurethral Sling: This is the most common surgical treatment for SUI. A synthetic mesh “sling” is placed under the urethra to provide support, much like a hammock. It’s a quick outpatient procedure with different placement techniques:
   • Retropubic Sling: Inserted behind the pubic bone.
   • Transobturator Sling: Placed through small incisions in the thighs.
3. Traditional Sling: For women who’ve had complications with synthetic mesh or who prefer a natural option, this method uses tissue from the lower abdomen or thigh to support the urethra. Recovery time is generally longer than for the midurethral sling.
4. Colposuspension (Burch Procedure): This surgery repositions the urethra by placing stitches on each side to support it. It can be done through an abdominal incision or laparoscopically. Recovery may take longer when performed through an abdominal incision.

Risks of Surgery

All surgeries carry risks. Some risks of SUI surgeries include:

• Injury to the bladder, bowel, blood vessels, or nerves
• Infections such as urinary tract infections (UTIs) or wound infections
• Difficulty urinating or continued leakage after the procedure
• Specific risks with synthetic mesh: Mesh may erode into surrounding tissue, potentially causing pain or infections.

Your healthcare provider will discuss these risks with you before surgery.

Recovery from Surgery

Recovery time depends on the type of surgery:

• Minimally invasive procedures like midurethral slings usually allow for same-day discharge.
• Traditional sling or abdominal surgeries may require a hospital stay.

After surgery, you may experience mild discomfort at the incision sites or need a catheter to help drain the bladder temporarily. Follow your provider’s guidelines to avoid strenuous activities like heavy lifting or exercise. Recovery can vary, but many women find their symptoms significantly improve with surgery.

Signs of a Problem After Surgery

Contact your healthcare provider if you experience any of the following symptoms post-surgery:

• Vomiting or fainting
• Redness or discharge at incision sites
• Abnormal vaginal discharge
• Difficulty urinating, burning during urination, or blood in urine
• Severe abdominal pain, heavy bleeding, fever, or chest pain

Key Takeaways

1. SUI Surgery is considered if nonsurgical treatments don’t improve symptoms.
2. Surgical options include urethral injections, midurethral slings, traditional slings, and colposuspension, each with specific benefits and considerations.
3. Recovery varies based on the procedure, and most women return to normal activities within a few weeks.
4. Risks include possible injury, infections, or urination issues; discuss these with your provider.
5. Seek medical attention for unusual symptoms after surgery.

Managing SUI Post-Surgery

After surgery, avoid activities that put stress on the surgical area. Follow-up visits allow your provider to monitor healing and advise when to resume regular activities. Success rates for SUI surgery are high, and recovery is generally quick for many women, allowing them to return to their daily lives with improved bladder control.