Medications are the first line of defense for many health conditions.

That’s an option for women suffering with stress urinary incontinence. But is it the only option? What are other treatment paths? 

Let’s look at management of stress urinary incontinence beyond medications, with alternative therapies that can help women who need it.

Understanding Stress Urinary Incontinence

If you’re a woman, you’ve likely experienced the occasional “leak,” a drip of urine when you laugh or cough. If it’s happening on a regular basis, you likely have a common condition known as stress urinary incontinence. In fact, about 1 in 3 women have this problem at some point in their lives.¹

Stress urinary incontinence or SUI happens when urine leaks out with sudden pressure on the bladder and urethra—the tube that carries urine from the bladder out of the body. The pressure causes the sphincter muscle that holds urine in the bladder to open briefly, creating a leak that can be a few drops or enough to soak through clothes.¹

Pressure that causes leaks come from sudden forceful activities like exercise, heavy lifting, sneezing, laughing or coughing. More severe cases of SUI can even create leaks with less forceful activities, like standing up, walking or bending over.¹

There are a number of risk factors that can increase the chances of getting SUI, such as pregnancy, vaginal childbirth, obesity, chronic coughing, and menopause. Other medical conditions may lead to it, such as pelvic surgery like a hysterectomy, or uterine prolapse.²

The Impacts of SUI 

It seems that older women have a greater incidence, with an estimate that half of women over age 65 have stress urinary incontinence. But it’s important for women to know that urinary incontinence is not a normal part of aging, and it’s a problem that can be treated.²

Unfortunately, it also seems that many women with SUI do not seek treatment, feeling that it isn’t warranted; feeling embarrassed to speak to a doctor about their condition; or fearing that treatment might require surgery. There may also be differences in how doctors understand, evaluate and care for the condition.³

Stress urinary incontinence can have negative impacts on women, leading to isolation because they’re afraid of being too far from a bathroom, or leaking in public. Some women give up exercising or playing sports, and even avoid sex in case of embarrassing leaks. Women who have changed the way they live need to know that there are treatment options.¹

What are the treatment options for stress urinary incontinence?

Medications for SUI

It’s true that some medications are used to treat stress urinary incontinence. Here are some examples:

1. Anticholinergic drugs: which block the action of the chemical messenger that triggers bladder contractions associated with an overactive bladder.⁴

2. Tricyclic antidepressants: which help with urethral contractions and closure.⁵

3. Estrogen: applied topically to increase urethral blood flow.⁵

4. Botox: injections into the bladder muscle to block that chemical messenger and paralyze the bladder muscle.⁴

This is a sample of medications that can be used, and each one of them comes with possible side effects. 

For instance, anticholinergics can lead to heartburn, blurry vision, rapid heartbeat, flushed skin, trouble urinating and cognitive side effects like trouble with memory and confusion. Botox may increase the incidence of urinary tract infections, and the Food and Drug Administration (FDA) warns about adverse reactions after the use of Botox.⁴ 

Taking a chance with troublesome side effects leads many women to look beyond medications for treatment.

Therapies for Stress Urinary Incontinence

There are products and devices that women can use to manage leaks:⁶

• absorbent pads
• a pessary, a vaginal insert designed to help SUI
• a urethral insert, a small tampon-like disposable device inserted into the urethra to act as a barrier to prevent leakage

Each of these options can give women the freedom to continue with regular activities, work and a social life without worry by helping them cope with leaks. 

Beyond simply managing the symptoms, there are ways to treat SUI. To understand treatment options beyond medication, it helps first to know the main cause of SUI in women: the loss of support from pelvic floor muscles and connective tissue.⁵ 

The pelvic floor is a group of important hammock-like muscles and tissues that support the pelvic organs, including your bladder and bowel. The pelvic floor holds these organs in place while also providing the flexibility to assist with bodily functions like peeing, pooping and sex. Weak muscles can lead to pelvic floor conditions like incontinence.⁷

That loss of support can happen when a woman has a pelvic surgery, or from other traumas to the tissues like vaginal delivery of a child, pregnancy, menopause, constipation, heavy lifting, smoking, chronic cough, and obesity.⁵

Some treatment suggestions are intended to manage symptoms—like the devices we mentioned above, or behavioral changes like limiting fluid intake or scheduling regular bathroom breaks. Those that treat the root cause—weakened pelvic floor muscles—are more effective at eliminating symptoms.

Pelvic Floor Muscle Exercises for SUI

One of the most powerful approaches to treating SUI is for women to take action with pelvic floor muscle exercises. Performing these exercises on a regular basis can strengthen the muscles that support the urinary system. 

Also known as Kegel exercises, these can be done as a preventive measure, but research has also shown that they are extremely effective as a treatment for incontinence. Kegels can help keep pelvic floor muscles stay “fit” in the same way that strengthening other muscles in the body boosts well being. 

Here’s a snapshot of study results that show Kegels are an effective therapy for incontinence:

• A review of research on women who performed Kegel exercises from pregnancy to postpartum showed that they “significantly reduced the development of urinary and fecal incontinence.”⁸
• Another study revealed that a dedicated program of Kegel exercises before performing resistance training improved average pelvic floor muscle strength and was effective in reducing SUI among incontinent women.⁹

Performing Kegels involves contracting or lifting the pelvic muscles—a similar contraction to when a woman is holding in her urine—and holding for 10 seconds before relaxing. It’s recommended that women do a few Kegels at a time, gradually increasing the number in each session.¹

Doctors often recommend seeing a pelvic floor physical therapist who can ensure the correct muscles are being worked, help a woman with the proper technique, and even provide biofeedback to confirm the technique. It can take 4-6 weeks of regular exercise to see symptoms improve.²

Another option to perform Kegels properly is by using the INNOVO Urinary Incontinence Kit. This product has been cleared by the FDA and includes a pair of “smart shorts” designed to strengthen the pelvic floor muscles from the inside out. The kit enables women to perform 180 perfect Kegels in 30 minutes. 

A clinical study guided by the FDA had amazing results: 87% of women were defined as dry after just 12 weeks, and 90% of users would recommend the therapy to others.

Surgery For SUI

Surgery is another alternative to treating incontinence instead of a regimen of ongoing medication. Surgery is typically designed to improve closure of the sphincter or support the bladder neck.⁶

The most common procedure is known as the sling procedure. To put it simply, a surgeon uses mesh to build a sling or hammock that supports the urethra. Caldera Medical offers a variety of slings for treating incontinence.

Urethral slings have become the most common type of surgery to correct SUI due to several advantages:⁵ 

• the procedure can be completed in as little as 30 minutes 
• discharge is usually the same day
• there’s usually no need for urinary catheterization 
• the recovery time is short
• there’s minimal pain
  

Another type of surgery is called “retropubic colposuspension.” This procedure attaches ligaments along the pubic bone to lift and support tissues near the bladder neck and upper portion of the urethra. It can be performed by an incision in the abdomen or laparoscopically.⁶

Finally, injectable bulking agents can be injected into tissues around the upper portion of the urethra, bulking up the area to improve the ability of the sphincter to close.⁶

Conclusion

Stress urinary incontinence has a major impact on the quality of life for many women, impacting their work life, social life, and for some even their sex life. The goal of treatment is to improve quality of life, but treatment can do more than manage the symptoms. While options can include a combination of behavioral treatment along with medications, improving the muscles of the pelvic floor is a powerful and effective treatment option. 

One study reported that cure rates with pelvic floor muscle exercises were 58.8% at 12 months.⁵ Performing regular exercise is certainly preferable to a regimen of medication with sometimes negative side effects. Exercise and, in more serious cases, surgery are treatment options beyond medications for women suffering from stress urinary incontinence.  

Women’s Pelvic Health issues in general are often not talked about due to embarrassment or lack of knowledge, leading women to believe they are alone with their condition. Whether you’re a woman suffering from stress urinary incontinence or you’re treating someone with this condition, it’s important to remember that you’re not the only one. Don’t go through this journey alone. 

There’s plenty of support, guidance and treatment options, including minimally invasive treatments offered by Caldera Medical, to help women regain confidence and live life to the fullest.