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Stress Urinary Incontinence (SUI)

Updated: Oct 17, 2020

Leakage can happen to anyone at anytime. It may surprise us out on the basketball court or catch us off guard with an untimely sneeze. We may even experience it while we’re sleeping, having sex, or simply sitting up in bed.

Whether it’s a drop, a diaper full, or some amount in between, it’s worthy of attention.

There IS hope for those who wear dark clothing to hide leakage, feel forced to wear pads “just in case,” or feel uncomfortable with their bodies.

A healthy relationship with your bladder is one where YOU are in control. 

If you're here, you or someone you care about is likely living with stress incontinence, and it’s affecting daily and social activities. Our goal is to empower you with knowledge and a plan to prevent it in the future. There IS hope!

What is stress urinary incontinence?

Stress urinary incontinence (SUI) is urine leakage with activity or exercise. The action causes increased force or "stress" on the bladder, and depending on the severity of your SUI, leaking could be brought on by more or less strenuous activities. (Ghaderi, 2014)

Women over 60 years old are diagnosed with SUI more than any other demographic, but though they are impacted the most, aging and being female are not preconditions for SUI. Stress urinary incontinence also affects younger women, men, and even children. (Buckley, 2010) 

The American Urological Association provided this list of factors that increase the risk of getting SUI:

• Pregnancy and childbirth

• Being overweight

• Smoking

• Chronic coughing

• Nerve injuries to the lower back

• Pelvic or prostate surgery

All of these factors play a part in weakening the pelvic floor muscles. Urine leakage with activity is a sign that your pelvic floor muscles lack the strength and/or coordination to close off the urinary exit canal.

Let’s break down the anatomy!

The anatomy of  your pelvic floor muscles (PFM)

People of all genders and all ages have layers of muscle that support their pelvic organs called pelvic floor muscles. They start in the front at the pubic bone and stretch to the tail bone in the back, functioning like an internal hammock at the base of the pelvis.

In females, the pelvic floor muscles wrap around the vaginal canal, the anus, and the urethra (the canal leading from the bladder). While in males, the pelvic floor muscles wrap around the urethra and the anus.  

The pelvic floor muscles help to control what goes out and what comes in. If your pelvic floor muscles lack strength, flexibility, or coordination, many problems can occur with each of these canals.  

With this information in mind, let's consider the bladder. Your pelvic floor muscles should be strong enough and coordinated enough to keep the urine exit canal closed until you choose to empty your bladder.

But, with stress urinary incontinence, this process isn’t working correctly.  Imagine that your bladder is like a water balloon. When you squeeze a water balloon without adequately closing the outlet, leaking will occur. The same thing happens with your bladder and your PFM--the pelvic floor muscles aren’t closing off the urethral canal and preventing leakage as they should.

The good news is that we can train them! Bladder and pelvic floor muscle retraining can be very effective at relieving many urination issues.  (Radziminska, 2018)

Treating stress urinary incontinence

Although surgery is an option, we strongly urge you to consider pelvic therapy and noninvasive treatments first.

Pelvic floor muscle training (PFMT) is the first-line recommended intervention for stress incontinence by the International Continence Society (ICS).

PFMT taught by a pelvic floor physical therapist has shown significant improvement within 3 months, (Davila, 2011), and is more effective than training at home alone (Felicissimo 2010, Ferreira 2010, Hung 2010).  A dedicated and expert pelvic floor physical therapist can develop and coordinate a treatment plan especially for you.

If you could reduce or stop leakage with exercise or activity, wouldn’t a few hours each week be worth it?  

Fixing the source of the problem the natural way saves money and resources by reducing or eliminating the need for costly pads, medications, and surgeries.

Ready to laugh without leaking? Here are some steps you can take now:

What experiences or tips do you have that can help others? We’d love to hear them. Please join the conversation in the comments section below.  

By Zemrie DaCosta with Jeanice Mitchell, PT and Emily Reul, PT, DPT



Ghaderi, F., & Oskouei, A. E. Physiotherapy for women with stress urinary incontinence: a review article. J Phys Ther Sci. 2014;26(9), 1493–1499. doi:10.1589/jpts.26.1493

Davila G. W. (2011). Nonsurgical outpatient therapies for the management of female stress urinary incontinence: long-term effectiveness and durability. Adv Urol. 2011: 176498. doi:10.1155/2011/176498

Buckley BS. et al. (2010). Prevalence of urinary incontinence in men, women, and children-current evidence: findings of the fourth international consultation on incontinence. J Urology. doi:10.1016/j.urology/2009.11.078

Radziminska A. et al. (2018) The impact of pelvic floor muscle training on the quality of life of women with urinary incontinence: a systematic literature review. Clin Interv Aging. 2018 May 17;13:957-965. doi: 10.2147/CIA.S60057.

Felicissimo MF, Carneiro MM, Saleme CS, Pinto RZ, da Fonseca AM, da Silva-Filho AL. Intensive supervised versus unsupervised pelvic floor muscle training for the treatment of stress urinary incontinence: a randomized comparative trial. Int Urogynecol J. 2010;21 (7):835-840.

Ferreira M, Santos PC. Impact of exercise programs in women's quality of life with stress urinary incontinence. Rev Port Saude Publica. 2012;3(1):3-10.

Hung HC, Hsiao SM, Chih SY, Lin HH, Tsauo JY. An alternative intervention for urinary incontinence: retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. Man Ther. 2010: 15(3):273-279.

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