Stress urinary incontinence (SUI) does not go away if you ignore it! It is a mistake to reduce your level of activity to accommodate incontinence. It is important to improve your pelvic muscle control, to improve your continence and enjoy the normal exertions of life more. This looks after your future self.


What is Stress Urinary Incontinence (SUI)?

What is SUI?

SUI is the involuntary loss of urine related to physical stress, such as during exertion, coughing or exercise. It is common but not normal.


Who is affected by SUI?

Women more commonly than men. Studies cite about 35 – 50% of women are affected. This increases with age, and following childbirth and menopause.  This is very much related to hormonal changes.


What is the relationship between oestrogen and SUI?

Oestrogen is our “plumper-upper” hormone for all the soft tissue cells in the pelvis. Over time, there is a reduction in cell volume and diminished function of these cells – mucosal, connective, muscle, tendinous, and ligamentous.


What are the causes for SUI?

There is usually a cluster of causes: weakness in pelvic floor muscles, a deficiency (thinning) of the urethral muscles (urine tube), a loss of fascial (ligamentous) support to the bladder and pelvic organs, and a change in body weight. There are other causes. Tight pelvic floor muscles can also cause urinary incontinence, as can a change in the shape of the bladder. Obesity can change how forces that maintain continence are transmitted around the abdomen and pelvis.


Risk factors

Risk factors for SUI include childbirth, pregnancy, morbid obesity, heavy lifting jobs and heavy exercise / sports, chronic cough and changes due to ageing. It can occur after spinal, pelvic, or hip surgery.


Why address the pelvic floor muscles?

Pelvic floor muscles surround and support the position of the bladder and urine tube. Strengthening the muscles and learning to contract the muscles at the correct time lift the urine tube and bladder, to reduce leakage.

International guidelines recommend physiotherapy as the first line of treatment for stress incontinence, with about 80% of women experiencing significant improvement. Typically, patients see a physiotherapist monthly for 6 months. Improvement requires diligence in completing exercises given as homework and implementing suggested changes.


Physiotherapy assessment

Initially the pelvic physiotherapist assesses the factors that are contributing to your incontinence. They will ask about your fluid intake, diet, toileting habits, exercise, obstetric and gynaecological history, bladder, and bowel history. A physical assessment includes examination of your abdomen, vulva, and vagina.

The physiotherapist may assess other areas if appropriate, including your spine and hips. Prolapse can co-exist with and contribute to SUI. Your physiotherapist will assess this issue as well.


Physiotherapy exercise and advice

Using this information, your physiotherapist will create a plan specific to your needs to reduce your SUI. Homework typically includes pelvic floor muscle exercises, addressing your current ability, specific areas of muscle weakness, and fatiguability of muscles. You will receive training specific to the situations in which you experience incontinence, and your current level of diligence (how consistently you can complete the training exercises)! Technique is important. Sometimes, the physiotherapist will recommend the use of a TENS (transcutaneous electrical nerve stimulator) if your muscles are very weak. These machines are inexpensive, easy to use and well tolerated. Reassessment of your pelvic floor over time highlights your progress.


What is the difference between strengthening exercises and functional exercises?

Strengthening exercises increase the bulk of the pelvic floor muscles (called levators) and their ability to contract. Functional exercises teach you to use the levators when you need to use them: for instance, when you cough, sneeze, lift babies or weights at the gym.


Frequently asked questions

Should I get help for SUI?

Definitely. The sooner you get help, the sooner you will be free of accidental wetness.


Will the physiotherapist give me homework?

Yes. This typically includes strengthening pelvic floor exercises. Occasionally, this will be combined with specific relaxation instructions.


How to manage menopausal symptoms effectively?

With your permission, the physiotherapist can contact your doctor, if the application of vaginal oestrogen is likely to improve your symptoms.


When will I see improvement?

Your physiotherapist will detect changes to muscle bulk and technique less than 6 weeks after you begin your exercise programme. You will know you are improving when you experience a reduction in leakage.



There is Level 1 evidence (the highest scientific evidence available) for physiotherapy management of incontinence. This is considered conservative management of the issue. Surgery (by a urogynaecologist) is undertaken only if physiotherapy fails to improve a person’s continence issues.
Our physiotherapists would be happy to help you manage and improve your pelvic issues.
Make an appointment at Maven with our expert physiotherapists: Annette Beauchamp and Cara Richmond.
We look forward to collaborating with you to help you to be your best.