What is stress urinary incontinence (SUI)?
Do PRP injections really help SUI?
How does testosterone help SUI?
Stress Urinary Incontinence (SUI)
Non-invasive treatment options for
Stress Urinary Incontinence
PRP
Injection
“A significant improvement in stress incontinence symptoms was observed 3 months after treatment [of platelet rich plasma] with a further improvement at 6 months. ... At the 6-month follow-up, 80.0% of women reported to be at least improved. No adverse effects were observed.”
Female Pelvic Medicine & Reconstructive Surgery, November 2021
“Low serum testosterone is associated with an increased likelihood of stress and mixed incontinence in women.”
The Journal of Urology, February 2018
What is stress urinary incontinence (SUI)?
Stress urinary incontinence is the unintentional loss of urine during physical movement or activity, such as coughing, laughing, sneezing, running or heavy lifting, puts pressure (stress) on your bladder, causing you to leak urine.
1) Mayoclinic.org. Stress Incontinence. Updated March 22, 2022. Accessed January 3, 2024. https://www.mayoclinic.org/diseases-conditions/stress-incontinence/symptoms-causes/syc-20355727.
How common is SUI?
Urinary incontinence of any cause is estimated to affect 24% to 45% of women.
Stress incontinence is the most common cause of all incontinence and accounts for 50% of cases.
1) Tran LN, Puckett Y. Urinary Incontinence. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559095/ 2) Reynolds WS, Dmochowski RR, Penson DF. Epidemiology of stress urinary incontinence in women. Curr Urol Rep. 2011;12(5):370-376.
What causes SUI?
1) Mayoclinic.org. Stress Incontinence. Updated March 22, 2022. Accessed January 3, 2024. https://www.mayoclinic.org/diseases-conditions/stress-incontinence/symptoms-causes/syc-20355727.
Stress incontinence occurs when the muscles and other tissues that support the urethra (pelvic floor muscles) and the muscles that control the release of urine (urinary sphincter) weaken. This is most commonly the result of childbirth. It appears to be more common in women who have had a hysterectomy. Factors that make stress incontinence worse include advaning age due to weakening muscles, obesity because of the pressure it puts on the abdomen/pelvis, and anything that causes coughing such as chronic illness or smoking.
Why treat SUI?
Stress incontinence can negatively impact quality of life, self-esteem, and social activity in women.
Haylen, B. T., De Ridder, D., Freeman, R. M., Swift, S. E., Berghmans, B., Lee, J., ... & Schaer, G. N. (2010). An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourology and Urodynamics: Official Journal of the International Continence Society, 29(1), 4-20.
How can you treat SUI?
1) Wu, J. M. (2021). Stress incontinence in women. New England Journal of Medicine, 384(25), 2428-2436. 2) Rovner, E. S., & Wein, A. J. (2004). Treatment options for stress urinary incontinence. Reviews in urology, 6(Suppl 3), S29. •de Vries, A. M., & Heesakkers, J. P. (2018). Contemporary diagnostics and treatment options for female stress urinary incontinence. Asian journal of urology, 5(3), 141-148. 3) Athanasiou, S., Kalantzis, C., Zacharakis, D., Kathopoulis, N., Pontikaki, A., & Grigoriadis, T. (2021). The use of platelet-rich plasma as a novel nonsurgical treatment of the female stress urinary incontinence: a prospective pilot study. Urogynecology, 27(11), e668-e672. 2) Long, C. Y., Lin, K. L., Shen, C. R., Ker, C. R., Liu, Y. Y., Loo, Z. X., ... & Lee, Y. C. (2021). A pilot study: Effectiveness of local injection of autologous platelet-rich plasma in treating women with stress urinary incontinence. Scientific reports, 11(1), 1584. 4) Athanasiou, S., Kalantzis, C., Zacharakis, D., Kathopoulis, N., Pontikaki, A., & Grigoriadis, T. (2021). The use of platelet-rich plasma as a novel nonsurgical treatment of the female stress urinary incontinence: a prospective pilot study. Urogynecology, 27(11), e668-e672. 5) Long, C. Y., Lin, K. L., Shen, C. R., Ker, C. R., Liu, Y. Y., Loo, Z. X., ... & Lee, Y. C. (2021). A pilot study: Effectiveness of local injection of autologous platelet-rich plasma in treating women with stress urinary incontinence. Scientific reports, 11(1), 1584.
There are no medications approved to treat stress incontinence in the United States right now. Non-medical treatments involve strengthening the pelvic floor muscles through exercises like Kegel’s. Strengthening the pelvic floor through electrical stimulation is now being performed as well. We hope to offer this soon.
Surgery is an option and attempts to support the urethra by numerous methods. There are over 200 different surgical procedures intended to rectify SUI. Less invasive treatments have been developed that inject bulking agents around the urethra to improve the ability of the sphincter to close. Insertable pessaries can also used to support the urethra.
Platelet Rich Plasma (PRP) injections into the anterior vaginal wall or peri-urethral area are being used to help regenerate pelvic floor muscles and improve nerve innervation to increase sphincter tone. The procedure is done in office under topical anesthesia to eliminate any discomfort that may be experienced.
There are multiple treatment options for stress incontinence. We encourage you to pursue the option you feel will best address your individual physiology, even if we don't offer that particular treatment. We can help you obtain the information you need to make an informed decision.
How does PRP help stress incontinence?
1) Chiang, C. H., & Kuo, H. C. (2022). The efficacy and mid-term durability of urethral sphincter injections of platelet-rich plasma in treatment of female stress urinary incontinence. Frontiers in Pharmacology, 13, 847520. 2) Saraluck, A., Chinthakanan, O., Kijmanawat, A., Aimjirakul, K., Wattanayingcharoenchai, R., & Manonai, J. (2023). Autologous platelet rich plasma (A‐PRP) combined with pelvic floor muscle training for the treatment of female stress urinary incontinence (SUI): A randomized control clinical trial. Neurourology and Urodynamics. 3) Nikolopoulos, K. I., Chrysanthopoulou, E., Pergialiotis, V., Korrou, L. M., Perrea, D. N., Dimitroulis, D., & Doumouchtsis, S. K. (2019). An animal experimental study on pubourethral ligament restoration with platelet rich plasma for the treatment of stress urinary incontinence. Central European Journal of Urology, 72(2), 134.
Stress urinary incontinence (SUI) is caused by weakening of muscles and other tissues that support the urethra (pelvic floor muscles) and the muscles that control the release of urine (urinary sphincter). It is postulated that the growth factors contained in PRP help restore function to those muscles providing greater control over the lower urethra.
The bulk of treatment for stress incontinence, whether through a vaginal pessary or surgical intervention, is designed to lift and support that lower urethra in order to increase urethral resistance. This has the effect of providing greater control over leaking urine. It is postulated that PRP injected in the anterior vagina helps build the connective tissue, including collagen, that naturally lifts and supports that part of the urethra restoring urethral resistance and control.
There is also research being done into the effects of PRP on the pubourethral ligament. The pubourethral ligament is important in stabilizing the normal anatomic position of the lower urethra. In rats, PRP has been shown to regenerate the function of the pubourethral ligament as measured by before and after leak point pressure of the urethra.
Do PRP injections really help SUI?
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PRP injections for stress incontinence are relatively new and have not had time for robust clinical evidence to be gathered. The following are excerpts from three different clinical studies regarding the efficacy of PRP injections for stress incontinence.
A recent study of PRP injections showed that “a significant improvement in stress incontinence symptoms was observed 3 months after treatment with a further improvement at 6 months. A mean reduction of 50.2% in urine loss was observed in the 1-hour pad test. At the 6-month follow-up, 80.0% of women reported to be at least improved. No adverse effects were observed.”1
“Local injection of platelet rich plasma seems safe with somewhat satisfactory response in treating female SUI both at 1 month and 6 months post treatment” and concluded that “PRP is a considerable treatment option for mild to moderate stress incontinence cases.”2
“Bivariate analysis revealed a significant incontinence improvement at both 1 month and 3 months post treatment without significant adverse reactions reported. …The result suggested that Local injection of autologous platelet rich plasma is a considerable treatment option in treating women with Stress urinary incontinence.”3
How does testosterone help SUI?
1) Kim, M. M., & Kreydin, E. I. (2018). The association of serum testosterone levels and urinary incontinence in women. The Journal of Urology, 199(2), 522-527. 2) Chen, Yingxiu, Xin Song, Weilin Fang, Tingting Lv, Jin Huang, Zhikang Cai, and Jianwei Lv. "Correlation of serum circulating testosterone levels with stress urinary incontinence in postmenopausal women." World Journal of Urology (2023): 1-6. 3) Siddle, N., & Versi, E. (2022). Stress urinary incontinence and the forgotten female hormones. International Urogynecology Journal, 33(7), 1711-1716.
Testosterone plays an important role in maintaining the pelvic floor musculature that supports the urethra and provides control over urination. It is the alteration of this musculature that leads to stress urinary incontinence (SUI). It has been called the "forgotten female hormone" because it has been overlooked as an important aspect of female hormone replacement therapy for its role in preventing and potentially reversing SUI. The following excerpts from scientific journals illustrate the correlation between low testosterone and SUI in women.
“Low serum testosterone is associated with an increased likelihood of stress and mixed incontinence in women. Given the role of pelvic musculature in maintaining urethral support and the anabolic effect of androgens on skeletal muscle, a physiological mechanism for this relationship can be proposed and further evaluated in prospective and translational studies.”1
“Serum testosterone levels were significantly lower in women with SUI than in healthy control women.
“The results of the present study indicate that low levels of serum testosterone are associated with an increased likelihood of stress urinary incontinence in women. Low serum testosterone levels may be a risk factor for SUI in postmenopausal women.”2
These findings have led medical providers to use testosterone as an effective, non-invasive treatment for SUI.