Stress urinary incontinence

Stress urinary incontinence (ang. stress urinary incontinence, SUI) is a disorder characterized by the involuntary leakage of urine in situations of increased intra-abdominal pressure, such as coughing, sneezing, laughing or physical exertion. This condition results from failure of the mechanisms that close the urethra and from disorders of the pelvic floor, which is responsible for the proper support of the pelvic organs. The problem primarily affects women, especially after childbirth and during menopause, but can also occur in men, for example after urological procedures. Stress urinary incontinence significantly affects patients' quality of life, social functioning and mental health.

Stress urinary incontinence – causes

The pathogenesis of stress urinary incontinence is multifactorial and includes both structural and functional disorders. A key role is played by weakening of the pelvic floor muscles and insufficiency of the urethral sphincter mechanism.

The most important causes include:

1. Mechanical injuries of the pelvic floor:

vaginal deliveries (particularly multiparity),
peripartum injuries,
gynecological and urological surgeries.

2. Hormonal changes:

estrogen deficiency during menopause,
atrophy of the urethral and vaginal mucosa.

3. Factors increasing intra-abdominal pressure:

obesity,
chronic cough (e.g., in COPD),
chronic constipation,
intense physical exertion.

4. Anatomic disorders:

pelvic organ prolapse,
excessive urethral mobility,
damage to supporting fascia and ligaments.

5. Neurological and systemic factors:

neurological diseases affecting bladder control,
aging,
genetic predisposition (weakened connective tissue structure).

Lifestyle is also important – lack of physical activity, improper lifting technique, or chronic stress may indirectly contribute to deterioration of pelvic floor function.

Stress urinary incontinence – symptoms

A characteristic symptom of stress urinary incontinence is the involuntary leakage of small amounts of urine in situations of increased intra-abdominal pressure, without an accompanying sensation of urgency to void.

The most common symptoms include:

urine leakage during coughing, sneezing, or laughing,
loss of urine during physical activity (e.g., running, lifting weights),
urine leakage when changing body position,
no prior sensation of an urgent need to urinate.

In more advanced cases:

leakage may occur with minimal exertion,
there is a marked limitation of physical and social activities,
patients often use urological pads or restrict fluid intake.

In contrast to urinary incontinence with urgency (so-called urge incontinence), stress urinary incontinence does not involve a sudden, difficult-to-control sensation of the need to void.

Stress urinary incontinence – degrees

Stress urinary incontinence is classified based on the severity of symptoms and the situations in which urine leakage occurs.

Grade I (mild):

urine leakage only during heavy exertion,
e.g., coughing, sneezing, intense physical activity,
often small amounts of urine.

Grade II (moderate):

urine leakage with moderate exertion,
e.g., brisk walking, climbing stairs, lifting objects,
symptoms more troublesome, affecting daily functioning.

Grade III (severe):

urine leakage with minimal exertion or at rest,
e.g., when changing body position, standing up,
significant reduction in quality of life, often necessitating the use of urological protective products.

This classification is clinically significant because it influences the choice of appropriate treatment method – from conservative therapy to surgical treatment.

Stress urinary incontinence – when to see a specialist

Visiting a specialist (a gynecologist, urologist, or urogynecologist) is recommended at the first signs of urinary incontinence, especially if the problem is recurrent or progressive.

The following should prompt a consultation:

regular episodes of urine leakage,
reduced quality of life and limitation of activities,
the need to use incontinence pads,
coexisting symptoms of pelvic organ prolapse,
no improvement despite pelvic floor muscle exercises.

Diagnostics include:

a detailed medical history,
physical examination,
urodynamic studies (assessment of bladder and urethral function),
imaging studies (e.g., pelvic floor ultrasound).

Modern therapeutic approach

Treatment of stress urinary incontinence (SUI) is staged and depends on the severity:

1. Conservative therapy:

pelvic floor muscle training (Kegel exercises),
urogynecological physiotherapy,
biofeedback and electrostimulation,
weight reduction and lifestyle modification.

2. Pharmacological treatment:

limited use in SUI, supportive in coexisting disorders.

3. Minimally invasive procedures:

procedures using radiofrequency energy (e.g., radiofrequency),
fractional laser therapy of the vagina,
injections of volume-enhancing substances (so-called bulking agents).

4. Surgical treatment:

suburethral slings (TVT, TOT),
pelvic floor reconstructive surgeries.

Contemporary aesthetic and regenerative medicine also offers methods that support tissue function, such as:

therapies stimulating collagen production,
procedures improving the tone and trophic condition of vaginal tissues.

Early intervention allows the use of less invasive methods and achieves better therapeutic outcomes. From a clinical perspective, stress urinary incontinence is a condition with a high potential for effective treatment, provided proper diagnostics and individually tailored therapy are applied.