Stress Incontinence -

Urinary incontinence is the loss of bladder control. Stress incontinence happens when movement or activity puts pressure on the bladder, causing urine to leak. Movements include coughing, laughing, sneezing, running or heavy lifting. Stress incontinence is not related to mental stress.

Stress incontinence is not the same as urgency incontinence and overactive bladder (OAB). Those conditions cause the bladder muscle to spasm. This leads to a sudden need to urinate quickly. Stress incontinence is much more common in women than in men.

If you have stress incontinence, you may feel ashamed. You might limit your work and social life because you don’t want to be with others. You also might not do physical or fun activities.

Treatment can help you manage stress incontinence and improve your quality of life.

If you have stress incontinence, you may leak urine when you:

Cough or sneeze.
Laugh.
Bend over.
Lift something heavy.
Exercise.
Have sex.

You might not leak urine every time you do one of these things. But any activity that puts pressure on your bladder can make leaking more likely. Having a full bladder increases the chances of leaking.

When to see a doctor

Talk to your healthcare professional if your symptoms bother you or get in the way of daily activities like work, hobbies and social life.

Stress incontinence happens when certain muscles and other tissues linked to urinating weaken. These include the muscles that support the urethra, called the pelvic floor muscles, and the muscles that control the release of urine, called the urinary sphincter.

The bladder expands as it fills with urine. Most often, valve-like muscles in the tube that carries urine out of the body, called the urethra, stay closed as the bladder expands. This keeps you from leaking urine until you reach a bathroom.

But when those muscles weaken, anything that puts force on the stomach and pelvic muscles put pressure on your bladder. Sneezing, bending over, lifting or laughing hard, for instance, can cause urine leakage.

Female stress incontinence

In people assigned female at birth, the pelvic floor muscles and urinary sphincter may lose strength because of:

Childbirth. Tissue or nerve damage during delivery of a child can weaken the pelvic floor muscles or the sphincter. Stress incontinence from this damage may begin soon after delivery or happen years later.

Male stress incontinence

In people assigned male at birth, the pelvic floor muscles and urinary sphincter may lose strength because of:

Prostate surgery. Treatment for prostate cancer often involves surgery to remove the prostate gland, called a prostatectomy. This surgery is the most common factor leading to stress incontinence. This procedure can weaken the sphincter, which lies right below the prostate gland and goes around the urethra.

Other factors

Other factors that can make stress incontinence worse for males and females include:

Illnesses that cause chronic coughing.
Obesity.

Factors that increase the risk of getting stress incontinence include:

Age. Physical changes that happen with age, such as muscles getting weaker, may make you more likely to get stress incontinence. But some stress incontinence can happen at any age.
Body weight. People who are overweight or obese have a higher risk of stress incontinence. Excess weight increases pressure on the abdominal and pelvic organs.

For females, risks factors also include:

Type of childbirth delivery. People who’ve had a vaginal delivery are more likely to have urinary incontinence than are those who had a cesarean section. Having more than one child also raises the risk.

Complications of stress incontinence may include:

Emotional upset. If you have stress incontinence, you may feel embarrassed. It can disrupt your work, social life, relationships and even your sex life. Some people are ashamed that they need pads or incontinence garments.
Mixed urinary incontinence. It’s common to have both stress incontinence and urgency incontinence. Urinary incontinence results when bladder muscles tighten and cause an urgent need to urinate. People with this condition may have frequent urination, urination in the evening and urgency to urinate with or without associated incontinence. This is called overactive bladder.
Skin rash or soreness. Prolonged contact with urine can cause skin to be sore or to break down. This can happen with severe incontinence if you don’t use moisture barriers or incontinence pads. Change pads often and use continence pads rather than menstrual pads to prevent skin sores.

During your visit, your healthcare professional looks for clues to the cause of your symptoms. Your appointment will likely include:

Voiding diary that tells how much you drink and when and how often you urinate.
Medical history.
Physical exam. This might include a pelvic exam in women and a rectal exam.
Test of a urine sample for infection or traces of blood.
Brief neurological exam to see how the pelvic nerves work.
Urinary stress test, in which your healthcare professional looks for urine loss when you cough or bear down with a full bladder.

Tests of bladder function

Common cases of urinary incontinence often don’t need other tests. But sometimes your healthcare professional might order tests to see how well your bladder, urethra and sphincter work.

Bladder function tests may include:

Measuring how much urine stays in your bladder after you urinate. You might have this test if there’s concern about your being able to empty your bladder all the way. People who are older, have had bladder surgery or have diabetes might need this test.
A specialist uses an ultrasound scan, which turns sound waves into an image. The test shows how much urine is left in your bladder after you urinate. Sometimes, the test involves passing a thin tube called a catheter through your urethra into your bladder. The catheter drains the urine that’s left so it can be measured.
Measuring bladder pressures. Urodynamics is a test that measures pressure in your bladder during filling and emptying. This test can check for stress incontinence and the strength of the pelvic floor muscles. Some healthcare professionals use these results to choose a surgical approach.
A catheter is used to fill your bladder slowly with warm fluid. As your bladder fills, you may be asked to cough or bear down to test for leaks. This procedure may be used with a pressure-flow study. This shows how much pressure your bladder uses to empty all the way.
Cystoscopy. This test uses a scope that is put into the bladder to look for conditions in the bladder and urethra that may be causing your symptoms. This procedure is usually done in a medical office.

Your healthcare professional may suggest a mix of ways to treat stress incontinence. If you have a urinary tract infection, you get treatment for the condition before starting treatment for stress incontinence.

Behavior therapies

Behavior therapies may help you have less or no stress incontinence. Treatments might include:

Pelvic floor muscle exercises. A member of your healthcare team or a physical therapist can help you learn how to do Kegel exercises to strengthen your pelvic floor muscles and urinary sphincter. For Kegel exercises to work, you must do them regularly.
A technique called biofeedback can be used along with Kegel exercises to make exercises work better. Biofeedback involves the use of pressure sensors or electrical stimulation to guide proper muscle contractions. Once your muscles are strong you can squeeze these muscles before doing anything that causes leakage to help keep from leaking.
Drinking fluids. Your health professional may suggest how much and what type of fluid you should drink during the day and evening and when. But don’t limit what you drink so much that your body loses too much fluid, called dehydration.
Healthy lifestyle changes. Quitting smoking, losing excess weight or treating an ongoing cough will lessen your risk of stress incontinence and improve your symptoms.
Bladder training. Your health professional might suggest a schedule for using the toilet if you have mixed incontinence. Urinating more often may help with urge incontinence.

Medicines

There’s no medicine approved to treat stress incontinence in the United States.

Female stress incontinence

Devices

A vaginal pessary may help control stress incontinence in people assigned female at birth. A urinary incontinence pessary is shaped like a ring with two bumps that sit on each side of the urethra.

Your healthcare professional can place this device for you. It helps support your urethra to prevent urine leakage during activity. The pessary needs to be removed and cleaned regularly.

There also are vaginal inserts that look like tampons that can support your urethra. You can get the inserts without a prescription. These devices are good choices for people who don’t want surgery. And the inserts can be thrown away after use.

Surgery

Surgeries to treat stress incontinence are designed to help the sphincter close or to support the bladder neck. Surgical choices for people assigned female at birth include:

Midurethral sling procedure. This is the most common procedure for stress urinary incontinence. It is a minimally invasive procedure that places a small piece of mesh under the urethra tube.
There have been media reports of problems with the use of mesh for vaginal prolapse repairs. But these mesh sling procedures are safe, and they work. Your surgeon will discuss the risk and benefits with the use of mesh with this type of surgery.
Bladder neck sling procedure. This procedure commonly is used when people have stress incontinence that keeps happening after a surgical procedure. It involves using a strip of tissue from the lower abdomen or thigh to make the sling. This procedure places the fascia at the bladder neck and uses a cut into the abdomen.
Bulking agents. Gels or other materials may be injected into tissues around the upper part of the urethra. These materials bulk up the area around the urethra.
Retropubic colposuspension. This surgical procedure uses stitches, called sutures, joined to ligaments along the pubic bone. These sutures lift and support tissues near the bladder neck and upper part of the urethra. This surgery can be done through small cuts, called laparoscopic incisions, or by a larger cut in the abdomen.

Male stress incontinence

Treatment for stress incontinence in people assigned male at birth might include:

Bulking agents. Gels or other materials may be injected into tissues around the upper portion of the urethra. These materials bulk up the area around the urethra.
Inflatable artificial sphincter. This device is put in surgically. A cuff fits around the upper portion of the urethra. It does the work of the sphincter. Tubes connect the cuff to a balloon in the pelvis that controls the pressure. A pump in the scrotum is controlled by hand.
Over time, the artificial sphincter might need more surgery to keep it working well.

References

Lukacz ES. Female urinary incontinence: Evaluation. https://www.uptodate.com/contents/search. Accessed Sept. 19, 2023.
Wu JM. Stress incontinence in women. New England Journal of Medicine. 2021; doi:10.1056/NEJMcp1914037.
Stress urinary incontinence (SUI). U.S. Food & Drug Administration. https://www.fda.gov/medical-devices/urogynecologic-surgical-mesh-implants/stress-urinary-incontinence-sui. Accessed Sept. 19, 2023.
Clemens JQ. Urinary incontinence in men. https://www.uptodate.com/contents/search. Accessed Sept. 19, 2023.
Lukacz ES. Female urinary incontinence: Treatment. https://www.uptodate.com/contents/search. Accessed Sept. 19, 2023.
Burzinski B, et al. Impact of stress urinary incontinence on female sexual activity. European Review for Medical and Pharmacological Sciences. 2021; doi:10.26355/eurrev_202101_24622.
Warner KJ. Allscripts EPSi. Mayo Clinic. Oct. 6, 2023.
FAQs: Surgery for stress urinary incontinence. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/surgery-for-stress-urinary-incontinence. Accessed Nov. 2, 2023.

Book your appointment TODAY!

Search on the closest Doctor to your location and book based on specialty. EARN 10 POINTS more with CuraPOINT.

BOOK

Edit Template

Stress Incontinence

When to see a doctor

Female stress incontinence

Male stress incontinence

Other factors

Tests of bladder function

Behavior therapies

Medicines

Female stress incontinence

Devices

Surgery

Male stress incontinence

Related Topics

Diabetes and Exercise

Exercise, Lifestyle, And Your Bones

How to Avoid Overheating During Exercise

Book your appointment TODAY!

Find a healthcare provider near you

Call for support

Feel free to message us!

About Us

Additional Links

AI Tools

Change the habbits