Stress urinary incontinence (SUI) is the involuntary loss of urine when intra-abdominal pressure rises suddenly — with coughing, sneezing, laughing, lifting, jumping, or exercise. It is caused by failure of the urethral closure mechanism: either the urethral sphincter itself is weak (intrinsic sphincter deficiency), the connective tissue support underneath the urethra is insufficient to provide a closing backstop (urethral hypermobility), or both.
In a continent woman, a sudden increase in abdominal pressure is transmitted equally to the bladder and the urethra. The urethral support mechanism keeps the urethra closed despite the elevated bladder pressure. In a woman with SUI, this support has failed: the rise in bladder pressure exceeds what the unsupported urethra can contain, and leakage results.
SUI is distinct from urge incontinence — leakage associated with a sudden compelling urge to urinate that cannot be deferred — which has different causes and different treatments. Many women with incontinence have elements of both — a pattern called mixed incontinence — and the evaluation at Lapeer Women’s Health specifically characterizes which component predominates to guide the most appropriate management.
SUI severity ranges from mild — occasional drops with severe coughing — to severe, where any physical effort produces leakage. The impact on daily life varies correspondingly.
- Leakage of urine with coughing — the most classic SUI trigger
- Leakage with sneezing — often the first symptom women notice
- Leakage with laughing — a frequent source of social anxiety and activity avoidance
- Leakage with exercise — running, jumping, high-impact aerobics, or sports
- Leakage with lifting — including lifting children, grocery bags, or at the gym
- Leakage with position changes — rising from a chair or bending forward
- Wearing pads or protective underwear to manage leakage
- Avoiding exercise, social situations, or activities because of fear of leakage
- Choosing clothing based on its ability to conceal incontinence
- Reduced sexual intimacy or avoidance of intercourse because of incontinence anxiety
If leakage with physical effort is affecting your activity level, your social life, or your willingness to exercise, it is affecting your health — and it has effective treatment options. You do not have to simply manage it with pads.
Vaginal Childbirth
Vaginal delivery produces stretching and potential injury to the levator ani muscles, the pubourethral ligaments, and the pudendal nerve branches that support urethral closure. The degree of SUI risk correlates with the number of vaginal deliveries, infant birthweight, duration of the second stage of labor, and use of forceps or vacuum. Women with a history of multiple vaginal deliveries of large infants have the highest obstetric SUI risk.
Estrogen Deficiency After Menopause
Estrogen maintains the thickness and vascularity of the urethral mucosa and the strength of the periurethral connective tissue. After menopause, estrogen deficiency produces thinning of the urethral mucosa and weakening of the periurethral support, reducing the passive closure pressure of the urethra and worsening stress leakage in women whose urethral support was previously marginal. Local vaginal estrogen improves urethral tissue health and can reduce SUI severity in postmenopausal women.
Obesity
Obesity significantly increases intra-abdominal pressure and the chronic load on urethral support structures. Weight loss in obese women with SUI produces meaningful improvement in incontinence severity — and in women with significant obesity, weight loss before surgical SUI treatment reduces surgical risk and improves surgical outcomes.
Chronic Cough and High-Impact Activity
Chronic cough from smoking-related lung disease, asthma, or other conditions produces repeated high-pressure loading on urethral support that, over time, contributes to support failure. High-impact exercise in women with marginal urethral support can be both a trigger and a contributing factor to SUI progression. Smoking cessation and management of chronic cough conditions are part of SUI management for affected patients.
SUI treatment at Lapeer Women’s Health is led by Dr. Ramona D. Andrei, MD, PhD, FACOG — from conservative measures through the most effective minimally invasive surgical procedures available.
Pelvic Floor Physical Therapy
Supervised pelvic floor physical therapy — not just unsupervised Kegel exercises — produces meaningful improvement in stress incontinence severity in most women with mild to moderate SUI. A trained pelvic floor physical therapist assesses pelvic floor muscle function, identifies specific weaknesses and coordination deficits, and designs a targeted strengthening and functional training program. It is the recommended first-line treatment for SUI before surgical discussion in most patients.
Pessary for Stress Incontinence
A continence pessary — a ring with a knob or incontinence dish — provides mechanical urethral support that reduces or eliminates stress leakage during physical activity. It is an excellent option for women who want non-surgical management or who wish to postpone surgery, and for women whose SUI is most bothersome during specific activities such as exercise. Learn about pessary fitting →
Midurethral Sling — Surgical Treatment
The midurethral sling is the current gold-standard surgical treatment for stress urinary incontinence, with the highest cure rates and the most extensive long-term evidence of any SUI procedure. A small mesh tape is placed beneath the mid-urethra through minimally invasive incisions, providing the support that the native tissue has lost. The procedure is typically performed as an outpatient under general or regional anesthesia with rapid recovery. Cure rates exceed 85 percent at long-term follow-up. Dr. Andrei performs midurethral sling procedures at our affiliated Michigan hospitals. Learn about incontinence surgery →
Stress urinary incontinence is one of the most effectively treated conditions in women’s health. Pelvic floor physical therapy produces meaningful improvement in mild to moderate SUI. A midurethral sling cures stress incontinence in more than 85 percent of women with a minimally invasive outpatient procedure and a rapid recovery. A pessary eliminates leakage during physical activity without any intervention at all.
The women who are still managing with pads, avoiding the gym, and choosing their clothing around incontinence anxiety have simply not yet had the evaluation that presents these options clearly. Dr. Ramona D. Andrei and the team at Lapeer Women’s Health are here to change that — at both our Lapeer and Rochester Hills offices, without a referral required.
Stress Urinary Incontinence
Our team at Lapeer Women’s Health provides pelvic floor therapy, pessary, and surgical options for stress incontinence at both our Lapeer and Rochester Hills offices. No referral required.
Schedule a Gynecologic VisitThe information on this page is intended for educational purposes only and does not constitute medical advice. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
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Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
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