Benign Prostatic Hypertrophy (BPH)
Stress Urinary Incontinence

Stress urinary incontinence is a common type of urinary incontinence that affects millions of people around the world. It occurs when physical activity places extra pressure on your bladder, causing involuntary urine leakage. Even a sneeze or cough can cause a leak.

Though not a serious medical illness, stress incontinence can be a source of embarrassment and distress. Knowing the risk factors and treatment options can help you manage the condition and live a more comfortable life.

Stress Urinary Incontinence

What Is Stress Incontinence?

If you have stress incontinence, small amounts of urine may be released when you cough, sneeze, laugh, exercise, or during other forms of physical activity. It occurs when the muscles that support the bladder and urethra are weakened or damaged, making it difficult to hold urine in the bladder. With moderate stress incontinence, more significant amounts of urine may be leaked during less strenuous activity such as bending over.

Who Does Stress Incontinence Affect?

Stress incontinence affects a wide variety of people and is more common in women than men. It is estimated that nearly one in five women will experience stress incontinence in their lifetime. It is also more common in older adults but can occur in people of any age.

Risk Factors

Many factors can increase your risk of developing stress incontinence. These include:

  • Pregnancy and childbirth: Pregnancy and vaginal childbirth can weaken your pelvic floor muscles, which can cause stress incontinence.
  • Obesity: Being overweight or obese can put extra pressure on your bladder and pelvic floor muscles, making it more difficult to hold urine in your bladder.
  • Age: As people age, muscles can weaken, increasing the risk of stress incontinence.
  • Surgery: Pelvic surgery, such as a hysterectomy, or surgery for benign prostatic hypertrophy or prostate cancer, can weaken pelvic muscles, which may result in incontinence.

Other risk factors include diabetes, nerve or back injuries, and chronic coughing.


Signs and Symptoms

The signs and symptoms of stress incontinence include:

  • Leaking urine when coughing, sneezing, or laughing
  • Leaking urine when exercising or during other physical activities
  • A sudden, strong urge to urinate
  • A feeling of not being able to hold your urine in
  • Accidental and unintentional voiding

How Is Stress Incontinence Diagnosed?

Your doctor can complete a physical exam and review your medical history to diagnose stress incontinence. To make the appropriate determination, you may be required to keep a bladder diary for two to three days to track your fluid intake, bathroom visits, and urine loss. This information will assist your doctor in making a diagnosis.

Your doctor may also order tests such as:

  • Urinary pad test: You’ll be asked to wear an absorbent pad at home for twenty-four hours. Then, your doctor will weigh the pad to determine the amount of urine lost.
  • Urinalysis: This test examines a urine sample for signs of infection.
  • Bladder scan: Your doctor will perform a brief ultrasound to ensure your bladder empties when urinating.
  • A pelvic or abdominal ultrasound: This type of ultrasound examines the bladder, kidneys, and other organs to determine their health.
  • A cystoscopy: Your doctor will use a scope to take a closer look at your urinary tract.
  • Urodynamic testing: This test measures how much urine remains in the bladder following urination.

Treating Stress Incontinence

Urinary incontinence is not a natural consequence of aging. It is a symptom of a problem that can often be treated successfully. There are several effective treatments available for stress incontinence, including:

  • Kegel exercises: This exercise strengthens your pelvic floor muscles and makes it easier to hold urine in your bladder. These exercises involve contracting and relaxing the muscles that control urination and bowel movements. Kegel exercises can be done easily at home.
  • Weight loss: Losing weight reduces pressure on the bladder which to helps manage stress incontinence.
  • Pessary: A pessary is a device that is inserted into the vagina to help support the pelvic organs and relieve symptoms of stress urinary incontinence. They are typically used as a non-surgical alternative to surgery, or as a temporary measure before surgery. A healthcare provider will help fit the pessary to the individual patient and teach them how to properly insert and remove the device.
  • Medications: Certain medications can help ease the symptoms of stress incontinence. Options include:
    • Anticholinergics: These medications work by relaxing the muscles of the bladder and preventing involuntary contractions, which can reduce the frequency and urgency of urination.
    • Alpha-adrenergic agonists: These medications can help to tighten the muscles of the urethra and reduce stress incontinence.
    • Topical estrogen: In women who have reached menopause, estrogen therapy can be applied topically to the vagina to help increase collagen and improve the strength of the pelvic muscles.
    • Duloxetine: This medication is a serotonin-norepinephrine reuptake inhibitor (SNRI) that has been approved for the treatment of stress incontinence in women.
  • Pelvic floor physical therapy: This is a type of rehabilitation that is performed by a physical therapist who specializes in treating conditions of the pelvic floor. The therapy usually includes an assessment of the pelvic floor muscles, as well as exercises and techniques to improve muscle strength, flexibility, and coordination.
  • Lifestyle changes: Setting yourself up for success by making certain lifestyle changes can help with the management of stress urinary incontinence. These include:
    • Avoiding bladder irritants: Certain foods and drinks, such as caffeine, alcohol, and spicy foods, can irritate the bladder and worsen incontinence.
    • Scheduling bathroom visits: Going to the bathroom on a set schedule can help to retrain the bladder and reduce the urge to go at inappropriate times.
    • Avoiding constipation: Straining to have bowel movements can put extra pressure on the pelvic floor muscles and worsen incontinence. Drinking plenty of water and eating a high-fiber diet can help prevent constipation.
    • Quitting smoking: Nicotine and other chemicals in cigarettes can irritate the bladder and worsen incontinence.
  • Surgery: In some cases, surgery may be necessary to repair or support the muscles of the bladder and urethra. Some of the most common surgical options include:
    • Sling procedures: A small piece of mesh or other material is placed under the urethra to provide support and prevent leakage.
    • Bulking agents: A substance is injected into the tissue around the urethra to help increase resistance and improve the closure of the urethra.
    • Bladder neck suspension: This procedure involves repositioning the bladder neck and urethra to a higher position within the pelvis to improve the closure of the urethra and reduce leakage.
    • Urethral diverticulectomy: This procedure is used to remove a pouch or sac that forms in the urethra, which can cause stress incontinence.
    • Artificial urinary sphincter: This procedure is used to insert a device that can be inflated and deflated to help control the flow of urine.

Find the Best Treatment Option for You

Stress incontinence can be very embarrassing and challenging, but it is essential to remember that treatment options are available to help you manage the condition. It is possible to manage your symptoms and enjoy a healthy and active lifestyle with the proper treatment. If you are experiencing symptoms of stress incontinence, it is important to schedule an appointment to determine the best course of action.

Frequently Asked Questions