Stress Incontinence: Symptoms, Causes and Treatment

01Physical stress

What physical stress means

Urinary incontinence is the loss of bladder control. Mayo Clinic explains that stress incontinence happens when movement or activity puts pressure on the bladder, causing urine to leak, and stresses that it is not related to mental stress. MedlinePlus describes it as the bladder leaking urine during physical activity or exertion.

The bladder expands as it fills, and valve-like muscles in the urethra, the tube that carries urine out of the body, normally stay closed until you reach a toilet. Mayo Clinic explains that when the supporting muscles weaken, anything that puts force on the abdominal and pelvic muscles, such as sneezing, bending over, lifting or laughing hard, also presses on the bladder and can push urine out.

02Symptoms

Leakage with cough, movement or exercise

The main symptom is leaking urine during effort. Mayo Clinic and MedlinePlus list situations such as:

• coughing or sneezing
• laughing
• bending over or lifting something heavy
• exercising or being physically active
• standing up from sitting or lying down
• having sex

Mayo Clinic notes that you might not leak every time you do one of these things, and that having a full bladder makes leakage more likely. The amount can vary from a few drops to more, and it often depends on the activity and how full the bladder is.

03Types

Stress, urgency and mixed incontinence

Stress incontinence is not the same as urgency incontinence and overactive bladder. Mayo Clinic explains that in those conditions the bladder muscle tightens or spasms, causing a sudden need to urinate quickly. People with an overactive bladder may pass urine often, including in the evening and at night, and feel urgency with or without leakage.

The two types can occur together. Mayo Clinic says it is common to have both stress and urgency incontinence, which is called mixed urinary incontinence. Noting whether leakage happens with effort, with a sudden urge, or both, helps the clinician work out which type is present, because the treatment differs.

04Causes

Support tissues, sphincter and risk factors

Two groups of muscles are involved. The pelvic floor muscles support the bladder and urethra, and the urinary sphincter is a muscle around the opening of the bladder that squeezes to prevent leakage. MedlinePlus explains that when either set of muscles becomes weak, urine can pass when pressure is placed on the bladder.

Causes and risk factors mentioned by the two sources include:

• childbirth, especially vaginal delivery and having more than one child
• pelvic organ prolapse, in which the bladder, urethra or rectum slides into the vagina
• surgery in the pelvic area or on the prostate
• injury to the urethra area and some medicines
• overweight and obesity, which increase pressure on the abdominal and pelvic organs
• illnesses that cause a chronic cough, and constipation
• age-related muscle weakness, although it can happen at any age

MedlinePlus adds that sometimes the cause is unknown.

05Women and men

Women, men and postoperative contexts

Stress incontinence is much more common in women than in men. Mayo Clinic explains that tissue or nerve damage during childbirth can weaken the pelvic floor muscles or the sphincter, and that leakage may begin soon after delivery or years later. MedlinePlus adds that damage during delivery can also lead to pelvic prolapse months or years afterwards.

In men, the most common factor is prostate surgery. Mayo Clinic explains that removing the prostate gland, often as part of prostate cancer treatment, can weaken the sphincter, which lies just below the prostate and surrounds the urethra. Symptoms in men are the same as in women: leaking with coughing, lifting, standing up or exercise. MedlinePlus notes that some treatments, such as an artificial urinary sphincter, are used mainly in men, so leaking after prostate surgery is worth raising with your doctor.

06Daily life

Impact on daily life and skin

Stress incontinence can affect much more than the bladder. Mayo Clinic notes that people may feel ashamed or embarrassed and limit work, social life, exercise and sex. MedlinePlus lists isolation, depression or anxiety, loss of productivity at work, loss of interest in sexual activity and sleep disturbances.

Physical complications are usually mild. They include sore or broken-down skin from prolonged contact with urine, irritation of the vulva, unpleasant odors and urinary tract infections. Mayo Clinic recommends changing pads often and using continence pads rather than menstrual pads to help protect the skin. Our guide on bladder control exercises covers related self-care.

07Assessment

Clinical assessment and selected tests

MedlinePlus explains that a health care provider will perform a physical exam, which may include a pelvic exam in women, a genital exam in men and a rectal exam. Tests are chosen according to each case and may include:

• a urine test to check for infection
• a voiding diary, in which you record urinary habits, leakage and fluid intake
• a urinary stress test, in which you cough while standing with a full bladder
• a pad weight test to measure how much urine is lost during exercise
• a measurement of the urine left in the bladder after urinating, or an ultrasound
• urodynamic studies, which measure bladder pressure and urine flow, and cystoscopy to look inside the bladder

Not everyone needs all of these. The aim is to confirm the type of incontinence, rule out other problems and plan treatment.

08Pelvic floor

Individual pelvic floor rehabilitation

MedlinePlus describes three types of treatment: behavior changes and bladder training, pelvic floor muscle training, and surgery. Treatment depends on how the symptoms affect your life. Pelvic floor muscle training can include Kegel exercises, biofeedback to help you identify and control the muscles, and pelvic floor physical therapy with therapists specially trained to evaluate the problem and guide exercises.

Behavior changes suggested by MedlinePlus include drinking less only if you drink more than normal amounts, avoiding drinks before bed, preventing constipation, stopping smoking to reduce coughing, cutting down on alcohol and caffeinated drinks, losing excess weight and keeping blood sugar under control if you have diabetes. Bladder training, urinating at regular intervals that are slowly lengthened, may also help. These measures work best when chosen for your situation; strict fluid restriction or giving up all exercise is not a general rule.

09Sources

Where the sources differ

Mayo Clinic’s page focuses on symptoms, causes and complications, while the MedlinePlus article also covers tests and treatment. Points to keep in mind:

• Medicines. MedlinePlus says there are no medicines approved for stress incontinence in the United States and that some providers prescribe an antidepressant off-label. Approval and practice vary between countries, so medication is a question for your doctor.
• Devices and surgery. MedlinePlus describes vaginal cones, bulking injections, urethral slings, retropubic suspensions and, mainly in men, an artificial urinary sphincter. Surgery is usually suggested only after nonsurgical treatment, and each option has its own risks.
• Outcomes. MedlinePlus says symptoms most often improve with nonsurgical treatment but that this does not cure the condition, and that surgery can cure most people. Results depend on the person, and factors such as poorly controlled diabetes, neurological disease, previous pelvic radiation or failed surgery reduce success.
• Exercise. MedlinePlus lists avoiding jumping or running among behavior changes, whereas Mayo Clinic points out that leakage leads some people to give up physical and fun activities, which itself harms quality of life. How to adapt exercise is best decided individually.

10Summary

In summary

Stress incontinence is leakage of urine when coughing, laughing, lifting, standing up or exercising, caused by weakness of the pelvic floor muscles or the urinary sphincter. Childbirth is the main factor in women and prostate surgery in men, with excess weight, chronic cough and age also playing a part. It can coexist with urgency incontinence.

Before an appointment, it helps to describe a few days of leakage episodes: what you were doing, whether you felt a sudden urge beforehand, roughly how much leaked and what you drank. Treatment ranges from behavior changes, bladder training and pelvic floor muscle training to devices and surgery, and is chosen according to how much the symptoms affect your life.