Treatment of Stress Urinary Incontinence in Women

A Medical and Surgical Review

Kristin Sanders, BSN, RN

Disclosures

Urol Nurs. 2019;39(1):29-35. 

In This Article

Abstract and Introduction

Abstract

Stress urinary incontinence (SUI) is the most prevalent form of incontinence in women. It can negatively impact a woman's physical, mental, and sexual health, as well as her social well-being. A stepwise approach is recommended for the treatment of SUI, beginning with conservative measures and progressing to more invasive treatments until the patient's desired quality of life is attained. Conservative options, such as behavioral changes, pelvic floor muscle training, and intravaginal support devices, are recommended as first-line therapy. Invasive treatments, including urethral bulking agents, bladder neck colposuspension, and sling procedures, should be considered once conservative measures have failed. This article provides an overview of SUI and summarizes the most common non-surgical and surgical treatment options.

Introduction

Urinary incontinence (UI) is defined by the International Continence Society (ICS) as "the complaint of involuntary loss of urine" (Haylen et al., 2010, p. 5). Urinary incontinence occurs in both men and women, although it is twice as common in women (Buckley & Lapitan, 2010). The International Consultation on Incontinence reviewed 36 general population studies and determined that in most studies, 25% to 45% of women report some degree of UI, while 9% to 39% of those over age 60 years report it as a daily occurrence (Buckley & Lapitan, 2010). However, the prevalence of UI is difficult to determine because patients are often reluctant to report due to factors such as embarrassment and the belief that it is an inevitable part of the aging process (Bardsley, 2016; Zilinskas, 2018).

In women, subtypes of UI are generally classified as stress, urge, or mixed (see Table 1) (Milsom et al., 2013). Stress urinary incontinence (SUI) is the most common form and will be the main focus of this article. According to Reynolds, Dmochowski, and Penson (2011), half of women with UI report SUI as their sole or primary symptom. The ICS defines SUI as the "complaint of involuntary loss of urine on effort or physical exertion (e.g., sporting activities) or on sneezing or coughing" (Haylen et al., 2010, p. 5). According to Milsom and colleagues (2009), young and middle-aged women are more likely to report SUI, while older women generally report urge and mixed incontinence. Research reveals that pregnancy increases the risk of developing SUI. Having a vaginal delivery is associated with a two-fold risk of developing SUI when compared to those who have had a cesarean section (31% vs. 15%) (Stothers & Friedman, 2011; Tähtinen et al., 2016). Additional risk factors for SUI include obesity, diabetes mellitus, genetic factors, hormones, medications, and smoking (Stothers & Friedman, 2011).

UI has the potential to negatively impact a woman's quality of life. Results of a systematic review performed by Seshan and Muliira (2014) concluded that any form of UI can affect a woman's physical, mental, and sexual health, as well as her social well-being. Many women with UI have feelings of shame, avoid sexual intimacy, abandon work, avoid physical activities, and limit fluid intake for fear of accidental urination. Lack of self-confidence and feeling unattractive were also reported and often led to alienation (Seshan & Muliira, 2014).

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