By: DelCharco M.D. OB/GYN
Stress urinary incontinence (SUI) — the involuntary leakage of urine during physical activities like coughing, sneezing, laughing, or exercising — affects many women. While it may begin as occasional dribbling, for many it becomes a persistent issue that impacts confidence, lifestyle, and comfort. The good news is that stress incontinence is treatable, and there are effective options tailored to different ages, stages of life, and lifestyle goals.
At Dr. DelCharco’s practice, we help women understand not just what treatments are available, but who they’re best for, how they work, and when to pursue them. This article provides an in-depth look at SUI treatment options, how they help, and how treatment decisions are made.
“Very efficient staff, knowledgeable physician, all around comfortable situation “
DelCharco M.D. OBGYN Patient Review
What Is Stress Urinary Incontinence?
Stress urinary incontinence occurs when the pelvic floor muscles and connective tissues that support the bladder and urethra weaken. With weakened support, increases in abdominal pressure — from actions like coughing, sneezing, lifting, or jumping — can push on the bladder and cause urine to leak.
SUI is distinct from urge urinary incontinence, where leakage is preceded by a sudden, intense urge to urinate; many women experience mixed incontinence with features of both.
Identifying the right treatment starts with understanding the specific type and severity of symptoms, as well as personal health goals.
Goals of Treatment
The primary goals in treating stress urinary incontinence are to:
- Reduce or eliminate leakage
- Improve bladder control
- Strengthen pelvic support
- Preserve or restore quality of life
- Provide long-term symptom relief with the least invasive approach appropriate
Treatment is individualized, meaning what’s best for one woman may not be best for another.
First-Line and Conservative Treatments
1. Pelvic Floor Physical Therapy
Who it’s for:
Nearly all women with mild to moderate stress incontinence, especially those whose symptoms are related to childbirth, pelvic floor weakness, or muscle coordination issues.
How it works:
A trained pelvic floor physical therapist evaluates muscle strength, coordination, and relaxation patterns. Therapy typically includes:
- Pelvic floor muscle training (Kegel exercises)
- Biofeedback, which helps you identify and control the right muscles
- Manual therapy to address muscle tightness or trigger points
- Education on posture and movement patterns
Why it helps:
Strengthening and retraining the pelvic floor can improve urethral support and reduce leakage over time. Many women experience significant symptom improvement with consistent therapy.
2. Lifestyle and Behavioral Strategies
Who they’re for:
Women with mild symptoms or those seeking support alongside other treatments.
Approaches include:
- Bladder training: Scheduled voiding to reduce urgency and improve bladder capacity
- Weight management: Excess weight increases pressure on the pelvic floor
- Fluid and diet management: Reducing bladder irritants like caffeine and carbonated drinks
- Timed voiding schedules: Planning bathroom trips to reduce accidents
Why it helps:
These strategies improve bladder and pelvic floor function without surgery or medication.
Medical and Minimally Invasive Options
3. Pessary Devices
Who it’s for:
Women who prefer non-surgical options, want immediate support, or are not candidates for surgery.
What it is:
A pessary is a removable device placed in the vagina that supports the bladder neck and urethra.
How it works:
By providing structural support from within, a pessary helps reduce leakage during activities that increase abdominal pressure.
Why it helps:
Pessaries are especially useful for women who want relief without surgery, women with pelvic organ prolapse, or those seeking temporary support (e.g., during pregnancy or while planning future surgery).
4. Medications
Who they’re for:
Some women with stress incontinence may benefit from medications that help improve urethral tone or bladder function. While fewer medications are approved specifically for SUI, certain drugs may be used off-label based on individual assessment.
How they work:
Medications may help improve bladder stability or enhance sphincter muscle tone. Your provider will evaluate risks, benefits, and potential side effects.
Why it helps:
Medications are often considered when conservative measures are insufficient, or in combination with other therapies.
Procedural and Surgical Options
When conservative and minimally invasive options don’t provide sufficient improvement — or when symptoms are moderate to severe — several effective procedures are available.
5. Mid-Urethral Sling Procedures
Who it’s for:
Women with moderate to significant stress urinary incontinence, especially those whose symptoms interfere with daily life and who are healthy surgical candidates.
What it is:
A mid-urethral sling uses a small strip of mesh placed under the urethra to provide support and prevent leakage during increases in abdominal pressure.
How it works:
The sling acts like a hammock under the urethra, improving closure during coughs, sneezes, and activity.
Why it helps:
This is one of the most commonly performed and well-studied surgical treatments for SUI, with high rates of long-term improvement.
6. Autologous Fascial Slings
Who it’s for:
Women who prefer to avoid synthetic mesh or have anatomy that makes synthetic slings less ideal.
How it works:
This procedure uses a strip of the patient’s own tissue (fascia) to support the urethra.
Why it helps:
Provides durable support without synthetic material, suitable for select patients.
7. Bulking Agents
Who it’s for:
Women with mild to moderate stress incontinence who want a less invasive option than sling surgery.
What it is:
Injectable bulking agents are placed around the urethra to increase its resistance to leakage.
How it works:
By “bulking up” tissue around the urethra, the opening closes more effectively during pressure increases.
Why it helps:
This is a quick outpatient procedure with relatively low risk, though repeated treatments may be needed.
How Treatment Decisions Are Made
Effective SUI care starts with a comprehensive evaluation at Dr. DelCharco’s practice. This typically includes:
- Detailed medical and symptom history
- Physical and pelvic exam
- Bladder diary to track symptoms
- Optional urodynamic testing for complex cases
- Shared discussion of goals, lifestyle, and preferences
From this foundation, your clinician will recommend the best combination of treatments tailored to your needs.
When to Seek Care
You should see a healthcare provider if:
- Leakage occurs with coughing, sneezing, or exercise
- Urine loss interferes with daily life or intimacy
- You’re avoiding activities you once enjoyed
- Symptoms persist despite pelvic floor exercises
Stress incontinence is not something you must simply accept. Effective treatments exist for nearly every woman — and the earlier you seek care, the more options you typically have.
“Office staff was very friendly, and she took time to let me explain what was going on and she explained what she thinks it is that is happening sending me for further testing to determine it.”
DelCharco M.D. OBGYN Patient Review
You Deserve Relief
Stress urinary incontinence can be treated, managed, and often significantly improved. From physical therapy and lifestyle strategies to minimally invasive devices and surgical options, there are solutions tailored to your unique situation.
At Dr. DelCharco’s practice, we work with you to identify the best treatment path, support you through care, and help you regain confidence and comfort. If stress urinary incontinence is affecting your quality of life, we encourage you to reach out and schedule an evaluation — relief is possible, and help is here.