What is stress urinary incontinence (SUI)?

Stress urinary incontinence (SUI) happens when there is involuntary urine leakage during activities that increase intra-abdominal pressure. Common activities causing SUI include coughing, sneezing, laughing, jumping, and lifting. A lot of people experience SUI- but it doesn’t have to be your normal!

What causes SUI?

There are multiple drivers of SUI. Healthy pelvic floors respond to increases in intra-abdominal pressure with a reflexive contraction to support the bladder and close the external urethral sphincter to maintain continence. When pelvic floor muscles are not strong enough to counteract increases in intra-abdominal pressure, or already overly active (thus preventing them from being able to further contract), urinary leakage occurs.

Other contributing factors to SUI include urethral hypermobility from ligamentous laxity, poor intra-abdominal pressure control, and hormonal changes. Often, SUI gets worse during peri- and post-menopause because of declining estrogen. When hormones are a contributing factor to SUI, an interdisciplinary approach with both physical therapy and an MD/PA/NP can be beneficial.

How can pelvic floor physical therapy help me?

Pelvic floor physical therapy for SUI includes addressing muscle imbalances, abdominal and breathing coordination, functional training and impact readiness, and postural training.

• Addressing muscle imbalances- For your pelvic floor to respond to changes in intra-abdominal pressure, it needs to be able to both contract and relax. Pelvic floor physical therapy ensures that your muscles are able to contract and relax properly, thus keeping you
• Abdominal and breathing coordination- Coordination between the diaphragm, your abdominal muscles, and your pelvic floor is crucial for continence. If your diaphragm and abdominal muscles are pushing pressure downwards onto your pelvic floor, it puts undue strain on your bladder and pelvic floor. Deep core stabilization and 360-degree breathing can help to support your bladder and pelvic floor, and to keep you
• Functional training and impact readiness- The pelvic floor can “learn” to contract before activities like sneezing or jumping that trigger SUI. Gradually loading the pelvic floor with progressive impact exercises can build tissue responsiveness and resiliency.
• Postural training- Suboptimal posture (slouching, or the opposite- an anterior pelvic tilt) can contribute to SUI by putting muscles at a disadvantaged position to support the bladder. Improving posture can decrease SUI.

Pelvic floor PT can decrease SUI, and help you live your life leak and pad free.