Stress Urinary Incontinence (SUI) Facts and Figures

What is urinary incontinence (UI) and stress urinary incontinence (SUI)?

• UI is involuntary loss or leakage of urine.
• According to the World Health Organisation (WHO), urinary incontinence is a widespread global disease and one of the last medical taboos for many people
• UI affects around one in three women worldwide.
• SUI is defined as accidental leakage of urine during physical activities such as sneezing, coughing, laughing, lifting or exercising.
• Urge urinary incontinence is accidental leakage of urine accompanied by or immediately preceded by urgency.
• Mixed urinary incontinence is accidental leakage of urine associated with urgency and also with activities such as sneezing, coughing, laughing, lifting or exercise.

Prevalence and impact of SUI on women:

• SUI, the most common type of UI in women, affects one in seven women worldwide.
• Nearly half of the women with urinary incontinence suffer from the symptoms of stress urinary incontinence (49%). Urge incontinence accounts for 22% of all incontinence and mixed incontinence accounts for 29% of all incontinence.
• SUI is more prevalent than other types of UI in younger and middle-aged women under 55 years.
• Despite the high prevalence of SUI, many women are reluctant to discuss their condition with their partners, friends or even with healthcare professionals. Shame and embarrassment are the key deterrents of seeking help. In fact, more than half of women with SUI do not seek help from a healthcare professional.
• SUI can have a profound impact on women’s quality of life as the condition can result in embarrassment, psychological distress, social isolation and loneliness.

What are the causes of SUI?

• Primary causes of SUI are events that directly damage pelvic floor muscles e.g:
  - Childbirth and pregnancy
  - Pelvic / abdominal surgery
  - Radiation therapy
• Contributing factors may increase a woman’s risk of developing SUI or make the condition worse:
  - Genetic factors, gender, neurological and muscular abnormalities
  - Lifestyle factors e.g. aging, obesity, lung disease and smoking (leading to increased coughing), urinary tract infection, neurological diseases
  - Pelvic floor disorders such as vaginal or uterine prolapse
  - Certain medications

How do women cope with SUI?

• Many women with SUI do not seek professional help and will try to cope with, or hide, their condition in the following ways:
  - Reducing fluid intake
  - Using absorbent pads in their underwear to absorb accidental leakage
  - Wearing dark clothing to hide leakages
  - Avoiding physical exertion that may trigger leakages
  - Knowing the location of all toilets in order to change their underwear in the event of accidental leakage

What current therapies can be used by women to manage their SUI?

• Conservative therapies for SUI include:
  - Pelvic floor muscle training (Kegel exercises) as well as:
  - - Biofeedback – probe to assist in pelvic floor muscle training
  - - Pelvic floor electrical stimulation
  - - Magnetic therapy/neuromodulation
  - - Weighted vaginal cones
  - Weight loss and smoking cessation, including regulation of food and fluid intake such as caffeine-containing drinks
  - Pessaries and/or devices such as intra-vaginal supporting tampons and intra-urethral seals and shields.
• Surgical options for SUI include:
  - Procedures that use natural or synthetic slings to support and compress the urethra
  - Colposuspensions that use the vaginal wall to support the position of the urethra and bladder neck
  - Artificial sphincters (an option rarely used)
• Pharmaceutical treatments:
  - There are pharmaceutical treatments available for SUI in Europe, however, there are currently no medications approved for SUI in Canada.

This information was made available with the assistance of Eli Lilly Canada Inc. The information is intended for informative purposes only and is not a substitute for professional medical advice. Please consult your physician with any questions or concerns you may have regarding your health.

REFERENCES
1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U et al. The standardization of terminology of lower urinary tract function: report from the standardization sub-committee of the International Continence Society. Neurourol Urodyn 2002;21(2):167-178
2. Voelker R, International group seeks to dispel incontinence “taboo”, JAMA 1998, Sep 16;280(11): 951-953
3. Hunskaar S, Lose G, Sykes D, Voss S. The prevalence of urinary incontinence in women in four European countries. BJU Int. 2004 Feb;93(3):324-30
4. Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. Int J Gynecol Obstet 2003;82:327-38
5. Fultz NH, Burgio K, Diokno AC, Kinchen KS, Obenchain R, Bump RC. Burden of stress urinary incontinence for community-dwelling women. Am J Obstet Gynecol 2003;189:1275-82
6. Hampel C, Wienhold D, Benken N, Eggersmann C, Thuroff JW. Prevalence and natural history of female incontinence. Eur Urol. 1997;32 Suppl 2:3-12. (Hampel data = 49% suffer from SUI with 30% prevalence)
7. Hannestad YS, Rortveit G, Sandvik H, Hunskaar S. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trondelag. J Clin Epidemiol. 2000 Nov;53(11):1150-7
8. Hannestad YS, Rortveit G, Hunskaar S. Help-seeking and associated factors in female urinary incontinence. The Norwegian EPINCONT Study. Epidemiology of Incontinence in the Country of Nord-Trondelag. Scand J Prim Health Care. 2002 Jun;20(2):102-79. Understanding stress urinary incontinence. Paul Abrams and Walter Artibani 200410. Urinary Incontinence Well-connected report July 2003. Reviewed by Harvey Simon, Harvard Medical School (7/11/2003) www.healthandage.com