The unseen burden: Stress urinary incontinence and how to treat it

Your bladder stores urine until you are ready to release it without worrying about leaks.

Most people usually urinate between six and seven times within 24 hours. With a healthy bladder, one should go about their daily business without leaking urine.

Stress urinary incontinence (SUI) is a problem with bladder control that leads to urine leaks. According to the World Health Organisation (WHO), SUI is a widespread condition, affecting around one in three women and is less common in men. It is one of the last medical taboos for many people.

SUI can prevent people from going to work, school, shopping, exercising, taking long trips and doing other activities they enjoy without the fear of being far from a restroom.

“Stress urinary incontinence is a sudden loss of urine due to abrupt increases in abdominal pressure, such as when one coughs, sneezes, laughs, lifts objects or does sit-ups,” explains Dr Gitobu Mburugu, a Consultant Urologist at Kenyatta National Hospital.

Dr Mburugu further states that stress urinary incontinence should be distinguished from urge incontinence, where you feel the urge to pass urine but it leaks before you get to the toilet, and overflow incontinence, where the bladder fills excessively and some urine leaks due to the overfull bladder.

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Stress urinary incontinence is usually caused by the weakening of the pelvic floor muscles, which can result from factors such as ageing, obesity, multiple childbirths, chronic cough, pelvic surgery, or radiotherapy.

“Any damage to the urethral sphincter muscles that keep the urethra closed, or damage to the nerves that activate these muscles can lead to stress incontinence. This can occur from prostate surgery, urethral surgery, pelvic fractures, or spinal cord injuries,” says Dr Mburugu.

For treatment, there are multiple options. Lifestyle modifications such as weight loss and avoiding bladder irritants like caffeine and alcohol, which increase urine production, can help. Physiotherapy, including pelvic floor muscle exercises to strengthen the pelvic floor muscles and bladder retraining such as scheduled urination to keep the bladder empty or near empty most of the time, is also recommended.

“If these options fail, medication such as the antidepressant duloxetine can be considered,” advises Dr Mburugu. “If all else fails, surgery is an option, and there are many types available,” he adds.

Dr Mburugu notes that SUI is more of a social and personal nuisance and can cause skin excoriation due to urine contact with the skin.

If you experience sudden involuntary leakage of urine with activities that abruptly increase abdominal pressure, it is advised to talk to a healthcare provider about your symptoms to find help.