FAQs | Urinary Incontinence & Stress Urinary Incontinence (SUI)
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What is urinary incontinence?

Urinary incontinence (UI) means losing urine when you don't want to - an involuntary loss or leakage of urine. According to the World Health Organization (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.

What is "urge" urinary incontinence?

Urge urinary incontinence is accidental leakage of urine accompanied by or immediately preceded by urgency.

What is "mixed" urinary incontinence?

Mixed urinary incontinence is accidental leakage of urine associated with urgency and also with activities such as sneezing, coughing, laughing, lifting or exercise.

How common is urinary incontinence?

As many as 3.3 million Canadians — nearly 10% of the population — experience some form of urinary incontinence. Unfortunately, very few people talk to their doctor about their symptoms. According to the Canadian Urinary Bladder Survey, 16% of men and 33% of women over the age of 40 have symptoms of urinary incontinence but only 26% have discussed it with their doctor.

Isn’t urinary incontinence just a normal part of aging?

No! The changes that occur as we get older (like menopause in women or prostate enlargement in men) may contribute to incontinence, but that doesn’t mean you just have to live with it. Almost all cases of urinary incontinence can be treated, managed or cured.

What’s the difference between urinary incontinence and over-active bladder?

An overactive bladder (OAB ) means you feel an urgent desire to go to the bathroom very frequently, whereas incontinence is leaking urine involuntarily. Sometimes, the two conditions go together. About half of people with OAB also have urge urinary incontinence (see page 6 for a definition), but you can have OAB without incontinence.

Where can I get help?

The Canadian Continence Foundation website (www.canadiancontinence.ca) is full of useful information and tips on how to manage urinary incontinence. You can sign up for our monthly newsletter, download helpful documents and/or order books and videos online. You will also find a list of doctors in your area who have expertise in treating urinary incontinence.

Stress Urinary Incontinence (SI)

What is "stress" urinary incontinence?

Stress urinary incontinence (SUI) is defined as accidental leakage of urine during physical activities such as sneezing, coughing, laughing, lifting or exercising.

What are the causes of SUI?

Primary causes of SUI are events that directly damage pelvic floor muscles. For example:

  • Childbirth and pregnancy
  • Pelvic / abdominal surgery
  • Radiation therapy

What surgical options are available for SUI?

  • 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)

What pharmaceutical treatments are available for SUI?

There are pharmaceutical treatments available for SUI in Europe, however, there are currently no medications approved for SUI in Canada.

What is the 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. (TYPES – USE color graphic from The Source)
  • 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 factors 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.

Male Stress Urinary Incontinence (SI)

What is "stress" urinary incontinence?

SUI in men is the involuntary loss of urine caused by pressure on the bladder during activities such as heavy lifting, exercise, sneezing, coughing and in some cases during sexual activity. This most commonly occurs following prostate surgery.

What causes SUI in men?

SUI is caused by a weakness in the pelvic floor most commonly following surgical removal of the prostate gland, either for an enlarged gland (trans-urethral resection of prostate, TURP) or for prostate cancer (radical prostatectomy), or radiation treatment. The prostate gland is located at the base of the bladder and surrounds the urethra, which is the pipe from the bladder along the penis. Here a ring of muscles called a sphincter close like a camera-shutter where the bladder and urethra join. In addition, there are supporting pelvic floor muscles that voluntarily close and stop urinary flow. These mechanisms together allow bladder control.. However, following. prostate surgery, if the bladder closing sphincter is removed or damaged, or the nerves controlling them are damaged, these muscles can become too weak to control urinary flow, this can result in leakage particularly when increased pressure on the bladder occurs.

What surgical options are available for SUI in men?

  • Artificial urinary sphincter - A fluid-filled ring that keeps the urethra shut is implanted around the urethra and acts as a sphincter. A valve that causes the ring to deflate is implanted in the scrotum: when you need to go to the bathroom, you press it to allow urine to flow through.
  • Male sling procedures - a strip of mesh tape inserted to support the urethra, keeping pressure on the urethra to prevent leakage.
  • ProActTM - an inflatable implant inserted near the bladder neck, a minimally invasive procedure and controlled through a port placed under the skin.

What pharmaceutical treatments are available for SUI in men?

There are no medications approved for use in Canada for SUI.

What is the prevalence of SUI in men following prostate surgery?

Prevalence of any type of UI is difficult to determine given reluctance to report and discuss the condition. Different data collection methods also make the information difficult to interpret. The most current prevalence information (ICS) provided in 2019 shows:

  • Post transurethral prostatectomy (TURP) for benign (non-cancerous) prostatic disease incontinence rates are between 0.5% and 3%.
  • Post radical prostatectomy prevalence rates for cancer, incontinence varies depending on the definition used and the duration of follow-up. However, the long-term incidence ranges between 4% and 8%.

What factors increase a man’s risk of developing SUI or making the condition worse?

  • Bladder problems before surgery.
  • Advanced age.
  • Previous radiation therapy.
  • Previous TURP.
  • Urethral trauma – e.g. A catheter pulled accidentally.
  • Lifestyle factors e.g. Aging, obesity, and frequent coughing, such as due to lung disease and smoking.

How do men cope with SUI?

Many men with SUI do not seek professional help leading to social isolation and depression. They will try to cope with, or hide, their condition by wearing dark clothing to hide leakages.

When will I be dry again?

Within 2-6 months, leakage should be less common. In some cases, leakage may last longer. You may find the treatment options and resources highlighted below helpful.

What is the prevalence of SUI in men following prostate surgery?

Seek advice from a urologist, nurse or physiotherapist for further guidance.

Conservative measures include:

  • Different reusable, disposable products and undergarments.
  • Condom catheter.
  • Weight loss and smoking cessation.
  • Avoiding constipation – straining with bowel movements.
  • Drinking plenty of fluids.
  • Pelvic Muscle Exercises - Kegel Exercises. These are more effective if performed before prostate surgery.
  • Biofeedback to help to identify the right muscles
  • Electrical Stimulation: - A probe placed on the pelvic floor muscles that delivers a low-grade electrical current, causing the muscles to contract.
  • Urethral Bulking Agents: - injected into the tissue that surrounds the urethra to build up the tissue around the sphincter.
  • Urethral Inserts for Men with Incontinence - 2020. Inserted into the urethra to prevent or reduce bladder leakage. Inserts are removed before passing urine and reinserted afterwards.
  • Penile Compression Devices or clamps are placed around the penis to compress the urethra.

Are there other resources available?

Before and After Radical Prostate Surgery by Virgina Vandall-Walker is a research-based, comprehensive, and comprehensible resource on prostate surgery in Canada. This invaluable guide includes chapters on preparing for prostate surgery, the surgery itself, recovery in hospital and at home, a list of recommended resources, and special sections to record personal notes and important contact information.

Please click on ‘The Source Guide’ the ‘Men’s Room’ or Continence Fact Sheets under the ‘Resources’ tab for more details.

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