Stress urinary incontinence is the leaking of urine when you are doing something that causes an increase in pressure in your abdomen. For example, a cough, a sneeze, if you run or if you lift a weight. This can happen to both women who have had children and those who have not. In fact we see it quite a lot in our young, female sporting population as well.

Why it happens

The reason why it happens is incredibly complex.

Sometimes it is that there is simply too much pressure from above the bladder. In these cases we look for ways to reduce this pressure. For example, we see if we can change the way you are using your abdominal wall, or if we can reduce the pressure by decreasing some of the tightness in your thorax or rib cage.

Other times, there is not enough support from below the bladder. The bladder is supported by both the pelvic floor muscles and from connective tissue. If these two structures are not holding the bladder up when there is an increase in pressure, such as from a sneeze, then the bladder will rotate and descend (urethral hypermobility) and this creates the leaking. If we think this is part of the clinical picture for your body then we will figure out what needs support, and support it so that the bladder does not descend with any increase in pressure.

Often however, it is a combination of both these two reasons and more.

How is it assessed?

• It is assessed by an internal examination. This allows us to assess both the bladder’s mobility and also the pelvic floor muscles themselves.

• We also use transperineal ultrasound. This allows us to visualise the bladder neck and watch whether it rotates and descends when under pressure like with a cough (watching for urethral hypermobility). It also allows us to visualise a pelvic floor contraction and ascertain whether it is possible to stop the descent of the bladder with the use of the pelvic floor, or not.

• Full body asessment: We will also be looking at your whole body especially your ribs and your abdominal wall. We need a lot of information in order to figure out all the contributing factors.

Treatment

The treatment is different for each and every person, but may include:

• Optimising your pelvic floor. This may include muscle releases, pelvic floor exercises and sometimes exercises to optimise the timing of your pelvic floor muscles

• Optimising the way you breathe.

• Releasing and retraining your ribcage

• Retraining the way you use your abdominal wall.

• Advice about exercise – what you can and can’t do.

• Advice on lifestyle (ideal weight, when to rest, how to effectively empty your bladder, defecation dynamics, etc.)

• Pessaries: Pessaries are devices that we insert up into the vagina in order to help hold the organs up. There are many different types of pessaries that are available and we use all of them including rings, cubes, gellhorns, shatz, and doughnuts. There is an art to a good pessary insertion and we are proud to say they we have a lot of experience in this field. For more information on pessaries see our Pessary information Sheet.

• Refering and liasing if we think necessary to gynaecologists, urogynaecologist, colorectal surgeons, etc.

• Advice and rehabilitation post surgery (if required)

• Releasing and retraining any other part of the body that we think may be contributing to the problem.