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Stress incontinence occurs when physical movements or activities like coughing, laughing, sneezing, running, or lifting heavy objects put pressure on your bladder, causing urine leakage. It’s important to clarify that this type of incontinence is unrelated to psychological stress. Unlike urgency incontinence and Overactive Bladder (OAB), which are characterized by bladder muscle spasms and a sudden urge to urinate. Stress incontinence is more commonly affects women than men.
The condition can be embarrassing, often leading individuals to limit social and work activities to avoid potential discomfort around others. It may also deter you from engaging in physical or enjoyable activities. However, there are effective treatment options available that can help manage stress incontinence, allowing you to improve your quality of life.
Symptoms
If you experience stress incontinence, you may notice urine leakage when you:
- Laugh
- Cough or sneeze
- Exercise
- Bend over
- Lifting heavy objects
- Have sexual intercourse
You may not necessarily leak urine every time you engage in these activities, but any action that puts pressure on your bladder can increase the likelihood of leaking. Additionally, having a full bladder raises the chances of leakage.
If your symptoms bother you or interfere with your daily activities such as work, hobbies, and social life, it’s important to discuss them with your healthcare professional.
Causes
Stress incontinence occurs when certain muscles and tissues involved in urination weaken. These include the pelvic floor muscles that support the urethra, and the urinary sphincter muscles that control the release of urine.
Normally, as the bladder fills with urine, the valve-like muscles in the urethra stay closed to prevent leakage until you reach a bathroom. However, when these muscles weaken, activities that exert force on the abdominal and pelvic muscles can put pressure on the bladder. For example, sneezing, bending over, lifting, or laughing vigorously can result in urine leakage.
Female stress incontinence
In individuals assigned female at birth, the weakening of pelvic floor muscles and urinary sphincter may be due to:
- Giving birth. The sphincter or pelvic floor muscles may become weaker as a result of tissue or nerve injury sustained during childbirth. This injury can cause stress incontinence, which might appear years after delivery or shortly after.
Male stress incontinence
In individuals assigned male at birth, the weakening of pelvic floor muscles and urinary sphincter may be caused by:
- Prostate surgery. Prostatectomy, the surgical removal of the prostate gland, is a common treatment for prostate cancer. The most frequent cause of stress incontinence is this procedure. The sphincter, which is located just below the prostate gland and surrounds the urethra, may become weaker as a result of this surgery.
Other factors
Male and female stress incontinence can also be exacerbated by the following factors:
- Being overweight.
- Conditions that result in persistent coughing.
Risk factors
The following factors raise the chance of developing stress incontinence:
- Age. Age-related physical changes, such as weakening muscles, may increase your risk of developing stress incontinence. However, stress urinary incontinence can strike at any age.
- Obesity. Obese or overweight people are more likely to develop stress incontinence. The abdominal and pelvic organs are under more pressure when one is overweight.
- Nerve damage. Damage to the lower back or pelvic nerves.
- Prostate cancer or benign prostatic hyperplasia (enlarged prostate) surgery in men.
- Having diabetes.
Among the other risk factors for females are:
- Type of childbirth delivery. Urinary incontinence is more prevalent among individuals who have had vaginal deliveries compared to those who have undergone cesarean sections. Furthermore, the risk increases with the number of childbirths.
- Having a hysterectomy surgery.
- Menopause.
Diagnosis
During your appointment, your doctor examines potential factors contributing to your symptoms. Your visit typically involves:
- Health history.
- A voiding diary tracks the amount of fluid intake, as well as the timing and frequency of urination.
- A physical examination. For women, this could involve a pelvic exam and a rectal exam.
- A quick neurological examination to assess pelvic nerve function.
- Examination of a urine sample for blood traces or infections.
- Urinary stress test: When you cough or bear down with a full bladder, your healthcare provider will check for urine loss.
Bladder function examination
In most cases of urinary incontinence, additional tests are not necessary. However, your healthcare provider may sometimes order tests to assess the function of your bladder, urethra, and sphincter.
These bladder function tests may include:
- Calculating the amount of urine that remains in your bladder following a urinal. If there is any reason to worry about your ability to completely empty your bladder, you may be scheduled for this test. This test may be necessary for those who have diabetes, are elderly, or have had bladder surgery. An ultrasound, which converts sound waves into a picture, is used by a professional. The test determines the volume of pee that remains in your bladder after urinating. A catheter may occasionally be inserted into your bladder through your urethra as part of the test. The catheter collects residual urine for measurement purposes.
- Measuring bladder pressures. Urodynamics is a test that assesses bladder pressure during both filling and emptying. It’s helpful in diagnosing stress incontinence and evaluating the strength of pelvic floor muscles. Healthcare professionals may use the results to determine the appropriate surgical approach.
During the test, a catheter is used to gradually fill your bladder with warm fluid. While your bladder fills, you may be instructed to cough or bear down to assess for leaks. This procedure may be combined with a pressure-flow study, which measures the pressure your bladder requires to empty completely. - Cystoscopy. This test utilizes a scope inserted into the bladder to examine conditions in the bladder and urethra that may be causing your symptoms. Typically, this procedure is conducted in a medical office.
Treatment
If you’re dealing with stress incontinence, your doctor might suggest a combination of treatment strategies. Should you have a urinary tract infection, addressing and treating this infection will be the priority before initiating any treatments for stress incontinence.
Behavior therapies
Behavioral therapies can assist in reducing or eliminating stress incontinence. Treatments may include:
- Pelvic floor muscle exercises. Your doctor can assist you in learning how to perform Kegel exercises to strengthen your pelvic floor muscles and urinary sphincter. Consistent practice is essential for Kegel exercises to be effective.
Biofeedback, a technique that uses pressure sensors or electrical stimulation to guide proper muscle contractions, can be combined with Kegel exercises to enhance their effectiveness. Once your muscles are strengthened, you can contract these muscles before activities that may cause leakage to prevent it.
- Drinking fluids. Your doctor may recommend specific amounts and types of fluids to consume throughout the day and evening, as well as when to drink them. However, it’s important not to restrict fluid intake to the extent that your body becomes dehydrated.
- Healthy lifestyle changes. Reducing your body weight, addressing a persistent cough, or giving up smoking will all help you feel better and reduce your chance of developing stress incontinence.
- Bladder training. If you have mixed incontinence, your doctor may recommend a schedule for using the restroom. Urge incontinence may be alleviated by more frequent urination.
Medicines
In the United States, there are currently no approved medications specifically for treating stress incontinence.
Female stress incontinence
Devices
A vaginal pessary can be an effective aid for managing stress incontinence in individuals assigned female at birth. This device, often shaped like a ring with two bumps, is designed to sit on either side of the urethra, providing support. Your doctor can fit and insert this pessary, which helps support the urethra and prevent urine leakage during physical activities. It requires periodic removal for cleaning.
Additionally, over-the-counter vaginal inserts, which resemble tampons, are available to support the urethra. These are disposable, non-surgical options that can be used and then thrown away after use.
Surgery
The goal of stress incontinence surgeries is to support the bladder neck or assist in closing the sphincter. Those whose birth assignment is female have the following surgical options:
- Midurethral sling procedure. The prevailing method for addressing stress urinary incontinence involves a minimally invasive procedure wherein a small mesh is inserted beneath the urethral tube.
While there have been media reports of issues with the use of mesh for vaginal prolapse repairs, mesh sling procedures for stress urinary incontinence are generally safe and effective. Your surgeon will discuss the risks and benefits associated with the use of mesh for this type of surgery.
- Bladder neck sling procedure. This procedure is often utilized when individuals experience recurrent stress incontinence following a surgical intervention. It involves using a strip of tissue from the lower abdomen or thigh to create the sling. The procedure positions the fascia at the bladder neck and requires an incision into the abdomen.
- Retropubic colposuspension. This surgical technique involves the use of sutures attached to ligaments along the pubic bone to support the tissues near the bladder neck and upper urethra. It can be performed through small laparoscopic incisions or a larger abdominal cut.
- Bulking agents. Gels or other materials can be injected into the tissues around the upper part of the urethra to add bulk to the area.
Male stress incontinence
For those who were assigned male at birth, treatment options for stress incontinence could include:
- Condom catheters. Condom catheters, also known as Texas catheters, encase the penis and feature a catheter at the tip to collect urine into a bag. While they effectively capture leakage, they do not prevent it.
- Bulking agents. Gels or other materials can be injected into the tissues around the upper part of the urethra to add bulk to the area.
- Inflatable artificial sphincter. This device is surgically implanted. A cuff is placed around the upper portion of the urethra, functioning as the sphincter. Tubes connect the cuff to a balloon in the pelvis that regulates pressure. A hand-controlled pump in the scrotum allows for manual operation. As time passes, the artificial sphincter may require additional surgeries to maintain its functionality.
