**By Una Lee, MD**
What is stress urinary incontinence?
Have you ever laughed so hard you leaked urine? Do you leak urine when you run, dance, or work out? If you do and it happens consistently, you may have stress urinary incontinence (SUI). SUI is a type of incontinence caused by pressure from a physical activity, including laughing, sneezing, or coughing. The pressure generated by the activity overwhelms the strength of the urinary sphincter muscle, and suddenly you feel a leak. Stress urinary incontinence is common among women and treatable.
What causes SUI?
SUI results from weakened muscles, including those that that support the bladder (pelvic floor muscles) and those that regulate the release of urine (urinary sphincter). In women, poor function of these muscles may be caused by tissue or nerve damage during delivery of a baby. Sometimes, SUI symptoms from this damage may begin soon after delivery or occur years later. A weakness of the urethra unrelated to childbirth can also cause SUI.
Can SUI be treated?
If it happens enough that it bothers you or affects your ability to enjoy exercising or being active, then lifestyle or behavior changes are the first things to try. Limit your fluids, especially alcoholic and caffeinated beverages which irritate the bladder, and empty your bladder before going on that hike or taking that exercise class.
Kegel exercises, which help strengthen your pelvic floor muscles and urinary sphincter, can be guided by a doctor or physical therapist to be more effective. Just like any other exercise routine, consistency is the goal for seeing results.
For some women a vaginal pessary is an option. A vaginal pessary is a disk fitted by your doctor that helps support the urethra to prevent leakage during activity. Pessaries are often used for people who also have pelvic organ prolapse. There are now over-the-counter, disposable versions of urethral support available.
Material injected into tissues around the urethra, in a relatively noninvasive procedure, can improve the sphincter’s ability to close. However the procedure is not a permanent repair, and most people will require repeat injections. Other surgical options include adding support (your own tissue or a thin strip of mesh) under and around the urethra to recreate urethral support. So when an activity causes increased pressure, there is a “backboard” to help close the urethra and prevent leakage.
SUI Clinical Trial
Clinical trials are research studies that identify what is safe and if a particular treatment works to improve a specific health condition. Participation is voluntary, and participants are educated on the possible benefits and potential risks. If you suffer from a particular health condition, such as SUI, participating in a clinical trial may be an option for you.
Currently, Virginia Mason is participating in a global clinical trial (with sites across the U.S. and Europe) of a new investigational procedure for SUI patients. It is called the Autologous Muscle Derived Cells for Female Urinary Sphincter Repair clinical trial. The trial is evaluating the safety and efficacy of using cells derived from a woman’s own muscle tissue (autologous cells) to potentially strengthen the sphincter muscle that helps control urine flow.
The science behind the trial – the idea that injected cells may help restore tissues of the urinary passage – represents an emerging area of study known as regenerative medicine. In regenerative medicine, specific types of cells are delivered to diseased tissues or organs for the purpose of restoring the tissue or organ function.
Una Lee, MD, is board certified in Urology and subspecialty certified in Female Pelvic Medicine and Reconstructive Surgery at Virginia Mason.