Stress urinary incontinence (SUI) is a leakage of urine during moments of physical activity that increases abdominal pressure, such as coughing, sneezing, laughing, or exercise. SUI is the most common type of urinary incontinence in women.
SUI can happen when pelvic tissues and muscles, which support the bladder and urethra, become weak and allow the bladder “neck” (where the bladder and urethra intersect) to descend during bursts of physical activity. This descent can prevent the urethra from working properly to control the flow of urine. SUI can also occur when the sphincter muscle that controls the urethra weakens. The weakened sphincter muscle is not able to stop the flow of urine under normal circumstances and when there is an increase in abdominal pressure. Weakness may occur from pregnancy, childbirth, aging, or prior pelvic surgery. Other risk factors for SUI include chronic coughing or straining, obesity and smoking.
Image Source: National Kidney and Urologic Diseases Information Clearinghouse
Women have both non-surgical and surgical options to treat SUI. Not every woman with SUI will need surgery. Some factors you should consider before deciding whether to undergo surgery include:
Examples of nonsurgical treatment options for SUI include:
Surgery to decrease or prevent urine leakage can be done through the vagina or abdomen. The urethra or bladder neck is supported with either stitches alone or with tissue surgically removed from other parts of the body such as the abdominal wall or leg (fascial sling), with tissue from another person (donor tissue) or with material such as surgical mesh (mesh sling). Surgical mesh in the form of a “sling” (sometimes called “tape”) is permanently implanted to support the urethra or bladder neck in order to correct SUI. This is commonly referred to as a “sling procedure.”
The use of surgical mesh slings to treat SUI provides a less invasive approach than non-mesh repairs, which require a larger incision in the abdominal wall. Slings can be anchored in the retropubic space or on the obturator area (via the thigh). There is also a “mini-sling” procedure that utilizes a shorter piece of surgical mesh, which may be done with only one incision.
Urologic surgeons at UCLA have developed an innovative “home-made” retropubic sling using mesh that is placed directly by the surgeon and avoiding trocars used by all other commercial slings and thus avoiding trocar placement complications. We have published 1-, 5- and 11-year follow-up data on this sling. The sling is durable and effective with minimal complications.
Long-Term Durability of the Distal Urethral Polypropylene Sling for the Treatment of Stress Urinary Incontinence >
Recently, there has been much controversy regarding the use of mesh in pelvic surgical procedures. At UCLA, we do not use mesh for vaginal prolapse procedures, but do use mesh for sling procedures. Learn more about the considerations regarding the use of surgical mesh for SUI (PDF) >
Treatment Options for Urinary Incontinence
Ja-Hong Kim, M.D., UCLA urologist, gives a complete overview of the pathology, diagnosis and treatment options for overactive bladder and urinary incontinence.
Video webcast >