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Treatments for SUI

The majority of women living with the urinary symptoms of stress incontinence can be treated successfully and resume a full and active lifestyle. In most cases, your doctor will start with less invasive treatments such as physical therapy and lifestyle and behavioral modifications. Medical devices or surgery may be recommended if these treatments do not adequately help your bladder control symptoms.

First Line Treatments

Physical Therapy

The goal of physical therapy for treating stress incontinence symptoms is to strengthen the pelvic floor muscles so that you can control urine output during everyday activities. Your physical therapist will perform a comprehensive internal and external exam of the pelvic floor muscles.

Pelvic Floor Muscle Exercises – Pelvic floor exercises can help prevent urine leakage by strengthening the pelvic floor and sphincter muscles. Your physical therapist will show you how to perform these exercises to promote muscle strengthening, relaxation, and coordination. Biofeedback can help determine if you are exercising the proper pelvic muscles.

Lifestyle Changes

Fluid and Diet Management - Changing the amount and timing of fluid intake during the day, as well as avoiding common dietary irritants such as caffeine and tomato-based foods, may help bladder function.

Losing excess weight and quitting smoking (which leads to chronic cough) can help eliminate some of the pressure on your bladder.

Minimally Invasive Surgical Treatments for SUI

Urethral Bulking

Urethral bulking involves the injection of a special material called a bulking agent. Your doctor can perform this minimally invasive procedure under local anesthesia in the office or an outpatient surgical center. The bulking agent helps build up the thickness of the urethral wall to support the bladder and form a tight seal to prevent urine leakage. Using a periurethral or transurethral approach, your doctor will inject the bulking material into the area around the urethra.

Bulkamid Hydrogel Therapy for Female SUI

Bulkamid is a soft hydrogel, also known as a urethral bulking agent, that acts as a barrier to prevent urine leakage. Consisting of 97.5% water, the hydrogel is natural and safe for the body. Delivered to the urethral opening by injection, Bulkamid provides additional volume to the urethra (the tube that carries urinary from the bladder to the outside of the body) to help prevent urine leakage from the bladder.


Urethral Sling

Urethral slings are a common and effective surgical treatment option for SUI. Your doctor will perform a minimally invasive procedure to place a sling, a small piece of synthetic mesh, under the urethra. The sling forms a hammock of support for your urethra, keeping it supported to eliminate accidental urine leakage.

Placement of the urethral sling is done as an outpatient procedure and only requires a small incision in the vagina. You can expect to go home a few hours after the procedure. Most women do not experience major pain or discomfort after the placement. You can return to light activity four to six weeks post-surgery; however, you should avoid heavy lifting, sexual intercourse, and rigorous exercise for four to six weeks following your procedure.

Secondary Surgical Treatment Options for SUI

Autologous Pubo-Vaginal Sling

An alternative to the urethral sling, the autologous pubo-vaginal sling is an option for women who do not wish to have the more common mesh sling implanted. This procedure utilizes the patient’s own fascia (connective tissue), taken from the thigh or lower pelvic area, to create the sling. Because your doctor uses your own tissue, there is no reaction to synthetic materials. The procedure, which is a more invasive, intricate surgery than a urethral sling, involves a small vaginal incision as well as two small incisions made above the pubic bone to insert and place the sling. A small incision in either the thigh or lower pelvis is also made to harvest the tissue.

Retropubic Suspension Surgery (Burch Procedure)

In some women, the bladder neck and urethra have dropped into the pelvic area, which causes involuntary urine leakage. Retropubic suspension surgery is a less common procedure that treats SUI by lifting the sagging bladder neck and urethra by attaching the bladder to structures behind the pubic bone to provide added support. This procedure is typically performed laparoscopically or through open surgery under general anesthesia through several small incisions in the abdomen.

Radiofrequency Bladder Neck Suspension

A less common alternative treatment, radiofrequency bladder neck suspension is a minimally invasive procedure where the pelvic tissue is gradually and precisely heated, allowing it to shrink and stabilize to keep the urethra from leaking. Your doctor may offer this therapy as a clinical trial or it may be offered off trial based on your insurance.