Stress No More: A First-Line Approach To Stress Urinary Incontinence (SUI)

Andrew Siegel MD   4/18/15


(Thank you for image above, Pixabay)

What Is SUI?

SUI is urinary leakage provoked by physical activities including sneezing, coughing, bending, lifting, exercising, and positional change. It men it most commonly occurs following radical prostatectomy for prostate cancer, although it can also occur after surgery done for benign prostate conditions. In women it most often occurs due to obstetrical “trauma” from pregnancy, labor and delivery, particularly prolonged labor and vaginal delivery of large babies, although it can also occur from any chronic increase in abdominal pressure (cough, constipation, etc.).

Main Brakes And Emergency Brakes

The urinary sphincters are the specialized muscles that provide urinary control. The main sphincter is composed of smooth muscle and is located at the bladder neck (where the urinary bladder and urethral channel meet) and is designed for sustained control. The auxiliary sphincter—located further downstream and comprised of skeletal muscle and contributed to by the pelvic floor muscles (PFM)—is designed for emergency control. I liken the main sphincter to the brakes of a car and the auxiliary sphincter to the emergency brakes.

Male SUI

In a man, when the main urinary sphincter (internal sphincter) is damaged as a consequence of surgery, the bladder neck is typically scarred in a fixed open position that no longer has the elasticity and suppleness to provide urinary control. Urinary control becomes dependent upon the auxiliary urinary sphincter (external sphincter). However, the auxiliary system is not designed for sustained contraction and although there is constant tone to this muscle, one can only achieve a relatively brief intense contraction.

Female SUI

In a female, the problem is not typically due to damage to the sphincter muscle as much as it is to weakened connective tissues that no longer can provide adequate support and a “backboard’ to the urethra.

The Cough Reflex

The cough reflex is a reflex contraction of the PFM when we cough. This squeezes the urethra and helps prevent urinary leakage. This is nature’s way of protecting us from leaking urine when there is a sudden increase in abdominal pressure, guarding us against cough-related SUI.

Aha! Nature is telling us something here and it is a good rule to always listen carefully to what wise Mother Nature tells us. Nature is informing us that a contraction of our PFM will help prevent SUI. So let’s build upon this and exercise our PFM to increase their strength, tone, and endurance.

Tapping Into The Power Of The PFM

We can replicate the cough reflex—voluntarily—when we are in situations other than coughing that provoke SUI. So, aside from just engaging in a PFM training regimen to increase PFM strength, tone and endurance, we can apply our improved PFM facility to the real life situation of SUI on an on-demand basis. In order to do so, we need to be attentive to the specific triggers that provoke the SUI. By actively squeezing the PFM immediately prior to the trigger exposure, the SUI can be prevented. For example, if changing our position from sitting to standing provokes SUI, doing a brisk PFM contraction when transitioning from sitting to standing should help control the problem. Bracing the PFMs immediately prior to an activity that precipitates the problem can be a highly effective means of managing SUI. When practiced diligently, it can ultimately become an automatic behavior.

Numerous scientific studies have shown the benefits of post-radical prostatectomy PFM training in helping to achieve an early return of urinary control and improving in the severity of incontinence in men. Many studies have also demonstrated the benefits of post-partum PFM training in facilitating an early return of urinary control and improving the severity of SUI in women.

To take it to the next level, committing to PFM training prior to undergoing prostate surgery in males or before pregnancy, labor and delivery in females, may prevent the occurrence of SUI.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in your email in box go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback:  

Co-creator of Private Gym pelvic floor muscle training program for men: 

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic muscle strength and tone. This FDA registered program is effective, safe and easy-to-use. The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximal opportunity for gains through its patented resistance equipment.


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