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Stress urinary incontinence (SUI) is the loss of urine that occurs at the same time as physical exertion. Activities like sneezing, coughing, or exercise increase the pressure or “stress” on the bladder. This pushes urine out of the body.
SUI affects one in three women over 45 years old. Women most commonly develop SUI from changes that happen in pregnancy or childbirth which weaken the support to the urethra. Chronic coughing, constipation, obesity, aging, smoking, or extreme weight lifting can also cause SUI. Genetics may also play a role.
The bladder walls are made of muscles. As urine flows into the bladder, the walls expand to make room for more fluid, like a water balloon. Sudden pressure caused by activity or “stress” unintentionally pushes urine through the urethra, the tube that carries urine out of the body.
Some women leak occasionally, for example, only with intense exercise, heavy coughing, or when their bladder is very full. Others leak with activities such as walking or laughing. Women may limit physical and social activities to avoid SUI. There is no need to do this—talk to your medical provider about treatments that can make you dry.
There are different kinds of urine leakage. To diagnose your problem, you will be asked questions about when and how often you leak urine. A physical exam will help identify other conditions that influence the bladder, such as pelvic organ prolapse. As part of the exam, you will be asked to cough or strain with a full bladder to see if you leak.
Urine analysis to check for a urinary tract infection and blood in your urine.
Ultrasound to assess how much urine remains in your bladder after urinating
Urodynamics to provide information on your bladder and urethra.
You may be asked to complete a bladder diary. This requires you to record what, how much, and how often you drink. You also measure the amount you urinate. This will help your provider learn more about your bladder symptoms.
The ideal SUI treatment depends on your symptoms and bother. You may want to first try conservative treatments such as lifestyle changes, pelvic floor muscle exercises, or a vaginal pessary. There are no medicines that help this problem.
Non-Invasive Pelvic Floor Treatment
Emsella is an FDA-cleared treatment that uses high-intensity focused electromagnetic energy to stimulate deep pelvic floor muscle contractions. Each session is equivalent to doing thousands of Kegel exercises in just 30 minutes. It’s an effective, non-invasive solution for stress urinary incontinence (SUI), helping to restore muscle strength and improve bladder control. Many women experience improvement after a series of treatments, with no downtime and comfortable, fully clothed sessions.
Non-Surgical Radiofrequency Treatment
EMFEMME 360 is an FDA-cleared, non-invasive treatment that uses radiofrequency to deliver gentle heat to the vaginal and pelvic tissues. This process promotes collagen remodelling, enhances circulation, and supports tissue tone, improving both pelvic floor strength and overall vaginal health. EMFEMME 360 is ideal for women looking to address pelvic discomfort and urinary control without surgery or downtime.
Most women find that pelvic floor muscle exercises (Kegels) help improve symptoms. For the best effect, work with a specialized physical therapist to learn the techniques. Ask your provider for a referral. Then use these exercises every time you feel a cough or sneeze coming. It may take 3 to 6 months of regular pelvic floor muscle exercise to see results.
A pessary is a silicone device inserted into the vagina. It is similar to a diaphragm. Pessaries push the urethra closed to help control urine leakage. They still allow you to urinate normally when you need to. Some women wear a pessary only when they exercise. Others leave it in all the time.
In this procedure, a substance is injected near the urethra to “bulk up” the walls. This works well when a sphincter muscle that circles the urethra weakens. There are different types of bulking agents. This outpatient procedure is usually done in the office. It is low risk and allows you to continue to be active immediately, but wears off after several months. The injections will need to be repeated.
SUI surgery addresses the weakened supports around the urethra. There are different SUI surgeries, including mid-urethral slings and urethral suspensions. Surgery is typically very successful and often low risk. But, not all women are candidates for surgery. Women who plan to get pregnant may want to wait until after their last pregnancy to have SUI surgery. Your provider will discuss each of these options with you to help tailor the best treatment for your specific condition.
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