Project 180498

Urinary incontinence affects up to 50% of adult populations and stress urinary incontinence (SUI) is the most common form of urinary incontinence, accounting for approximately 60% of patients. SUI is the leakage of urine on exertion or during tasks that increase pressure on the bladder such as sneezing or coughing. SUI appears to have many contributing factors such as structural damage (eg. pelvic floor muscle tears or tears in the supporting tissues incurred during childbirth), muscle weakness related to nerve injury or aging, or thinning of the urethral wall or its surrounding muscular sphincters. Currently the most common treatments are conservative therapy, which normally takes the form of exercise therapy provided by specialized nurses or physical therapists, and surgery, which is aimed at enhancing urethral support to compensate for muscle weakness or tissue tears. Exercise therapy is effective, resulting in improvements in 80% of patients and complete cure in 50% of cases, and surgery is effective for approximately 80% of patients. It is currently not clear why so many treatments fail, but it is likely because treatment for SUI needs to be tailored to the specific defects affecting individual patients. Through the proposed research, we are aiming to determine how to predict which patients will improve or be cured with exercise therapy and which ones will be cured by surgery. Specifically we will determine what is different between patients in whom treatments succeed and in whom the different treatments fail. We will also study how pelvic floor muscle exercises affect the mechanics of the continence system in women with stress urinary incontinence, and will determine whether physiotherapist-supervised training of the pelvic floor muscles before one particular type of surgery improves surgical outcomes.