Definition

What is stress incontinence?

Urinary incontinence is the unintentional loss of urine. Stress incontinence happens when physical movement or activity — such as coughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder. Stress incontinence is not related to psychological stress.

Stress incontinence differs from urge incontinence, which is the unintentional loss of urine caused by the bladder muscle contracting, usually associated with a sense of urgency.

How common is stress incontinence?

Stress incontinence is much more common in women than men. Stress incontinence (SI) is the most common type of incontinence suffered by women, especially older women. In addition, women who have given birth are more likely to have stress incontinence. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of stress incontinence?

The main symptom of stress incontinence is a leakage of urine at times of physical movement or activity. Examples of the kinds of activities associated with urine leaking include laughing, coughing, lifting, or exercise.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes stress incontinence?

With stress incontinence, movements and activities such as coughing, sneezing, and lifting put greater abdominal pressure on the bladder. That causes the leakage of urine.

A number of things can contribute to stress incontinence. For instance, it can result from weak muscles in the pelvic floor or a weak sphincter muscle at the neck of the bladder. A problem with the way the sphincter muscle opens and closes can also result in stress incontinence. Chronic coughing, smoking, and obesity may also lead to SI.

Stress incontinence, especially in women, is often caused by physical changes to the body. Things that can cause these changes include:

  • Pregnancy and childbirth
  • Menstruation
  • Menopause
  • Pelvic surgery
  • Problems with muscles in the bladder — the organ that holds urine — and the urethra
  • Weakened muscles around the bladder

In cases of stress incontinence, the muscles in the pelvis can weaken. This can cause the bladder to drop down into a position that prevents the urethra from closing completely. The result is a leakage of urine.

Risk factors

What increases my risk for stress incontinence?

There are many risk factors for stress incontinence, such as:

  • Although stress incontinence isn’t a normal part of aging, physical changes associated with aging, such as the weakening of muscles, may make you more susceptible to stress incontinence. However, occasional stress incontinence can occur at any age.
  • Type of childbirth delivery. Women who’ve had a vaginal delivery are more likely to develop urinary incontinence than women who’ve delivered via a cesarean section. Women who’ve had a forceps delivery to more rapidly deliver a healthy baby may also have a greater risk of stress incontinence. Women who’ve had a vacuum-assisted delivery don’t appear to have a higher risk for stress incontinence.
  • Body weight. People who are overweight or obese have a much higher risk of stress incontinence. Excess weight increases pressure on the abdominal and pelvic organs.
  • Previous pelvic surgery. Hysterectomy in women and particularly surgery for prostate cancer in men can alter the function and support of the bladder and urethra, making it much more likely for a person to develop stress incontinence.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is stress incontinence diagnosed?

During your visit, your doctor looks for clues that may also indicate contributing factors. Your appointment will likely include a:

  • Medical history
  • Physical exam with particular focus on your abdomen and genitals
  • Urine sample to test for infection, traces of blood or other abnormalities
  • Brief neurological exam to identify any pelvic nerve problems
  • Urinary stress test, in which the doctor observes urine loss when you cough or bear down

Tests of bladder function

Your doctor might order urodynamic tests, which are used to assess the function of your bladder. Testing isn’t necessary in most cases of uncomplicated stress urinary incontinence.

Bladder function tests may include:

  • Measurements of post-void residual urine. If there’s concern about your ability to empty your bladder completely, particularly if you are older, have had prior bladder surgery or have diabetes, a test of your bladder efficiency may be needed.

To measure residual urine after you have voided, a thin tube (catheter) is passed through the urethra and into your bladder. The catheter drains the remaining urine, which can then be measured. Or a specialist may use an ultrasound scan, which translates sound waves into an image of your bladder and its contents.

  • Measuring bladder pressures. Some people, particularly if they have had a neurologic disease of the spinal cord, will need cystometry. Cystometry measures pressure in your bladder and in the surrounding region during bladder filling.

A catheter is used to fill your bladder slowly with warm fluid. Tests of your bladder leakage will be done during the filling to check for stress incontinence. This procedure may be combined with a pressure-flow study, which tells how much pressure your bladder has to exert in order to empty completely.

  • Creating images of the bladder as it functions. Video urodynamics uses imaging to create pictures of your bladder as it’s filling and emptying. Warm fluid mixed with a dye that shows up on X-rays is gradually instilled in your bladder by a catheter while the images are recorded. When your bladder is full, the imaging continues as you urinate to empty your bladder.
  • This is an examination of the bladder and urethra using a scope inserted into the bladder. This procedure is usually completed in the office.

You and your doctor should discuss the results of any tests and decide how they impact your treatment strategy.

How is stress incontinence treated?

Your doctor may recommend a combination of treatment strategies to end or lessen the number of incontinence episodes. If an underlying cause or contributing factor, such as a urinary tract infection, is identified, you’ll also receive treatment for the condition.

Behavior therapies

Behavior therapies may help you eliminate or lessen episodes of stress incontinence. The treatments your doctor recommends may include:

  • Pelvic floor muscle exercises. Called Kegel exercises, these movements strengthen your pelvic floor muscles and urinary sphincter. Your doctor or a physical therapist can help you learn how to do them correctly. Just like any other exercise routine, how well Kegel exercises work for you depends on whether you perform them regularly. A technique called biofeedback can be used along with Kegel exercises to make them more effective. Biofeedback involves the use of pressure sensors or electrical stimulation to reinforce the proper muscle contractions.
  • Fluid consumption. Your doctor might recommend the amount and timing of fluids you consume during the day and evening. However, don’t limit what you drink so much that you become dehydrated.

Your doctor may also suggest that you avoid caffeinated and alcoholic beverages because it’s believed that in some people these dietary irritants affect your bladder function. But, new research suggests that coffee and caffeine may not increase stress incontinence. If you find that using fluid schedules and avoiding dietary irritants significantly improves leakage, you’ll have to decide whether these changes are worth the improvement in leakage.

  • Healthy lifestyle changes. Quitting smoking, losing excess weight or treating a chronic cough will lessen your risk of stress incontinence as well as improve your symptoms.
  • Bladder training. Your doctor might recommend a schedule for toileting (bladder training) if you have mixed incontinence. More frequent voiding of the bladder may reduce the number or severity of urge incontinence episodes.

Medications

There are no approved medications to specifically treat stress incontinence in the United States. The antidepressant duloxetine (Cymbalta) is used for the treatment of stress incontinence in Europe, however.

Symptoms quickly return when the drug is stopped. Nausea is the most common side effect that makes people stop taking the medication.

Devices

Certain devices designed for women may help control stress incontinence, including:

  • Vaginal pessary. A specialized urinary incontinence pessary, shaped like a ring with two bumps that sit on each side of the urethra, is fitted and put into place by your doctor or nurse. It helps support your bladder base to prevent urine leakage during activity, especially if your bladder has dropped (prolapsed).

This is a good choice if you wish to avoid surgery. A pessary will require routine removal and cleaning. Pessaries are used mostly in people who also have pelvic organ prolapse.

  • Urethral inserts. This small tampon-like disposable device inserted into the urethra acts as a barrier to prevent leakage. It’s usually used to prevent incontinence during a specific activity, but it may be worn throughout the day.

Urethral inserts aren’t meant to be worn 24 hours a day. Urethral inserts are generally used only for heavy activity, such as repeated lifting, running or playing tennis.

Surgery

Surgical interventions to treat stress incontinence are designed to improve closure of the sphincter or support the bladder neck. Surgical options include:

  • Injectable bulking agents. Synthetic polysaccharides or gels may be injected into tissues around the upper portion of the urethra. These materials bulk the area around the urethra, improving the closing ability of the sphincter.

Because this intervention is relatively noninvasive, it may be appropriate to consider before other surgical options. However, it’s not a permanent repair. Multiple injections are required for most people.

  • Retropubic colposuspension. This surgical procedure — done laparoscopically or by abdominal incision — uses sutures attached either to ligaments or to bone to lift and support tissues near the bladder neck and upper portion of the urethra.
  • Sling procedure. This is the most common procedure performed in women with stress urinary incontinence. In this procedure, the surgeon uses the person’s own tissue, synthetic material (mesh), or animal or donor tissue to create a sling or hammock that supports the urethra.

Slings are also used for men with mild stress incontinence. The technique may ease symptoms of stress incontinence in some men.

  • Inflatable artificial sphincter. This surgically implanted device is primarily used to treat men. A cuff, which fits around the upper portion of the urethra, replaces the function of the sphincter. Tubes connect the cuff to a pressure-regulating balloon in the pelvic region and a manually operated pump in the scrotum.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage stress incontinence?

The following lifestyles and home remedies might help you cope with stress incontinence:

  • Shed extra weight. If you’re overweight — your body mass index (BMI) is 25 or higher — losing excess pounds can help reduce the overall pressure on your bladder and pelvic floor muscles. Moderate weight loss may markedly improve stress incontinence. Talk to your doctor for guidance on weight loss.
  • Add fiber to your diet. If chronic constipation contributes to your urinary incontinence, keeping bowel movements soft and regular reduces the strain placed on your pelvic floor muscles. Try eating high-fiber foods — whole grains, legumes, fruits and vegetables — to relieve and prevent constipation.
  • Avoid foods and beverages that can irritate your bladder. If drinking coffee or tea (regular or decaf) seems to make you urinate and leak more frequently, try eliminating that drink, especially on days you really don’t want to be bothered by leakage.
  • Don’t smoke. Smoking can lead to a severe chronic cough, which can aggravate the symptoms of stress incontinence. Smoking is also a factor in many cases of bladder cancer.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: September 13, 2017 | Last Modified: September 13, 2017

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