Stress Urinary Incontinence (SUI)

What is urinary incontinence?

Incontinence is any involuntary leakage of urine. It affects both men and women but is commoner in women. Even young persons can suffer from this, though the incidence increases with age. The severity can vary from leaking only small amounts occasionally, to large and embarrassing leaks.

How common is urinary incontinence?

It is a very common condition, and up to one quarter or one third of people after 50 years of age will have some degree of urinary incontinence. However many people are embarrassed by it, and often choose to suffer in silence.

What are the kinds of urinary incontinence?

Stress incontinence (SUI): this leakage happens when you put pressure on the bladder while coughing, sneezing, straining etc. It happens usually in women and less often in men.

Urge incontinence (UI): this happens with a sudden, uncontrollable urge to pass urine, causing leakage before you can reach the bathroom. It is often associated with frequent passing of urine.

Mixed incontinence: some persons can have both urge and stress incontinence.

Other types of incontinence like overflow, neurogenic etc are rarer.

How to diagnose Stress Incontinence?

In most cases your doctor will be able to diagnose SUI from a detailed history and physical examination alone. Also he will ask for a urine test and sonography of the bladder. Occasionally he may advise a more detailed study with urodynamic testing.

Can Stress Incontinence be treated?

SUI can generally be treated with surgeries with excellent results. In milder cases with minimal leakages, surgery may not even be required. In such cases pelvic (Kegel) exercises, timed voiding (to empty the bladder before it becomes full), and occasionally medicines will often solve the problem.

What options do I have for treating SUI with surgery?

There are many procedures which can be used to treat and cure SUI. The treatment will vary from person to person, depending on the cause and extent of SUI. Your doctor can advise which procedure is likely to work best in your particular case.

1. Sling procedures like TOT or TVT:
A sling made either of synthetic mesh or your own body tissue is placed under the urethra, to support it and stop leaks. The sling can be anchored to the retropubic tissues (TVT or Trans-Vaginal Tape) or in the Obturator foramen (TOT or Trans-Obturator tape). These are minimally invasive and painless procedures which can be done with short hospital stays (1 to 2 days) and have a very quick recovery. These are the commonest surgeries performed for stress urinary incontinence, and they have excellent results – more than 90 percent of women are cured with no leaks. The results remain durable over time.

2. Bladder neck suspension:
These surgeries hitch the bladder neck to the pubic bone or nearby ligaments. These procedures are reserved for more complicated cases of SUI, or where earlier procedures have not worked well.

3. Urethral bulking agents:
In some women, SUI is not due to poor urethral support, but results from an intrinsically short or defective urethra. In such cases bulking agents like Macroplastique, Deflon or PAHG (polyacrylamid hydrogel) can be injected into the urethra to narrow the lumen and support the sphincter. These are also simple and painless procedures, with very few side effects, and short hospital stays of 1 to 2 days. While they do have good results, the improvements often reduce over time, so some may require repeat injections.

4. Artificial Urinary Sphincter:
An inflatable cuff is implanted around the urethra or bladder neck, to keep it squeezed shut and stop leaks. Each time you want to pass urine, the cuff can be deflated by pressing a control button placed in the labia (in women) or the scrotum (in men). This opens the cuff and allows you to pass easily. After a few minutes, the cuff again inflates automatically, hence stopping the leakages