Detailed definition
Stress urinary incontinence (SUI) is leakage with effort or exertion. Underlying mechanisms include urethral hypermobility (loss of pelvic floor support allows the urethra to descend and lose its closure mechanism with increased abdominal pressure) and intrinsic sphincter deficiency (the urethral sphincter itself is weak). Risk factors include vaginal delivery (especially with prolonged second stage or operative delivery), obesity, chronic cough, advancing age, and possibly genetic factors. Postmenopausal estrogen deprivation contributes modestly via thinner urethral submucosal vasculature. First-line treatment is pelvic floor muscle training (Kegel exercises with proper technique, ideally with a physical therapist), weight loss when relevant, and pessary support for some patients. Surgical options include midurethral slings (most common). Vaginal estrogen does not reliably treat SUI. Duloxetine has a small effect.
Why it matters in menopause
Pelvic floor PT is genuinely effective for many women with mild-to-moderate SUI, but most women have never been referred. The expectation that "this is just what happens after kids and menopause" is wrong. Specialty referral to urogynecology or pelvic floor PT is appropriate for women whose SUI affects daily activity or quality of life.
Related terms
Sources
External references: Wikipedia.