Stress urinary incontinence is the unintentional leakage of urine. It can affect people whose pelvic floor muscles have become weakened, for example, as a result of weight gain or childbirth.

It often happens when coughing, sneezing, or exercising.

Over 15 percent of adult women experience some form of incontinence in their lifetime, including stress urinary incontinence (SUI).

SUI is the most common form of urinary incontinence. It affects women more often than men.

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Stress incontinence can be awkward and embarrassing.

The primary symptom of stress incontinence is the involuntary leakage of urine.

This can happen when a person:

  • Coughs
  • Exercises
  • Laughs
  • Lifts something heavy
  • Sneezes
  • Stands up

It may not happen every time a person does these things, but any activity that increases pressure in the pelvis can trigger it, especially when the bladder is full.

The kidneys create urine, and urine passes through the ureter to the bladder for storage. The pelvic floor muscles help keep urine in the bladder.

To release the urine, these muscles relax.

The pelvic floor muscles wrap around the underside of the bladder and the rectum.

Several factors can lead to weakness in these areas.

Pregnancy and childbirth

Tissue, muscle or nerve damage can occur during childbirth. This can lead to stress incontinence soon after delivery or some years later.

A vaginal birth, an episiotomy, or a forceps delivery may also increase the risk.

Multiple deliveries, giving birth to an infant with a heavy birthweight, and a prolonged labor may also contribute to pelvic muscle weakness.

Doing regular pelvic floor exercises during pregnancy and after childbirth may reduce the risk of developing stress incontinence.

Other factors

A number of other factors can lead to stress incontinence.

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Stress incontinence mainly affects women, but it can happen to men, too.

Age: the risk increases with age, as the pelvic muscles and urethral sphincter weaken over time.

Previous pelvic surgery: men who undergo surgery for prostate cancer may develop stress incontinence.

A hysterectomy: surgical removal of the uterus may also be a factor.

Other risk factors that may intensify or trigger stress incontinence include:

  • Diabetes, which can cause excess urine production and nerve damage
  • Excess consumption of caffeine or alcohol
  • Illnesses that cause chronic coughing or sneezing
  • Medications that increase urine production
  • Obesity
  • Smoking, which can cause frequent coughing
  • Urinary tract infections

Complications

Complications include:

Skin rash or irritation: skin that is constantly in contact with urine can become irritated and sore. Using a moisture barrier or incontinence pads may help.

Emotional difficulties: embarrassment and distress are common with any type of incontinence. This can disrupt work, social activities, interpersonal relationships, and sexual relations.

Specialized tests can detect problems with bladder function. Treatment will depend on the results of the tests.

Treatment will normally begin with pelvic floor exercises to strengthen the pelvic muscles.

If these exercises do not help, treatment is available to tighten or support the bladder outlet. This may involve some kind of device, medication, or surgery.

If there is an underlying cause, such as a urinary tract infection or a more serious bladder problem, specific treatment will address this issue.

Pelvic floor exercises

Exercises can be done independently, or with the help of a physical therapist.

The first step is to become aware of which muscles need strengthening. One way to strengthen the pelvic floor muscles is through Kegel exercises.

  1. Sit in a chair with knees slightly apart. Squeeze the muscle just above the entrance to the anus. There should be some movement in the muscle. Do not move the buttocks or legs.
  2. Imagine you are passing urine and are trying to stop the stream. The muscles you use will be different from those in the first exercise. They are nearer the front.
  3. Focus on these muscles. You should feel a gentle lift of the vulva and vagina when doing the exercises.
  4. Squeeze the pelvic muscles 10 to 15 times in a row. Try to repeat this at least three times a day.
  5. Alternate the two types, focusing only on these muscles, without holding your breath or clenching the stomach, thighs, and buttocks.

Slow squeezes can develop stamina, and quick squeezes can help develop a quicker reaction time in moments of urinary stress, like sneezing.

Kegel exercises are discreet and can be done at any time.

Daily practice will strengthen the pelvic floor and increase the ability to hold the muscles for longer.

Aim to build up to holding for 10 seconds, and add more squeezes weekly to increase the effectiveness.

Kegel exercises should normally be carried out at least three times a day for 3 months. Benefits should become apparent after 3 weeks.

Continuing the exercises less intensively, even after symptoms have gone, can help maintain bladder stability.

Devices

Devices that may strengthen pelvic floor muscles include:

  • a vaginal cone
  • weights for inserting vaginally to support Kegels
  • an electrostimulator, which may help in the strengthening process by causing convulsions in the muscles
  • vibrating devices to assist Kegel exercises

However, there is little evidence that these are more effective than exercises alone. Patients should speak to a healthcare specialist before trying these methods.

Other devices that may help include:

Vaginal pessary: a flexible device that is fitted by a health care professional. When inserted into the vagina it may help support the bladder and decrease urine leakage. It is removed nightly or weekly for cleaning and care. This device may help to avoid surgery. Complications are rare but can include damage to the vaginal tissue.

Urethral plug: a small, disposable device for inserting into the urethra, the tube through which urine leaves the body.

This device can prevent incontinence for short periods during a specific activity, such as exercise, but it can increase the risk of urinary tract infections and blood in the urine.

Surgery

Surgery usually aims to improve and support the function of the bladder. It is normally advised only if other methods have failed.

Surgical interventions include:

Injectable bulking agents: Collagen, synthetic sugars, or gels may be injected into tissues around the upper portion of the urethra. This increases pressure on the urethra and improves the closing ability of the sphincter. This is typically done in the doctor's office.

Colposuspension: this common surgical procedure uses sutures, or stitches. These are attached near the bladder neck and upper portion of the urethra to create support. There are different ways of doing this, so the patient should discuss the best option with their doctor.

Sling procedure: the surgeon either uses the person's own tissue or a synthetic material to create a "sling" that supports the urethra. Slings are around 80 percent effective. They are commonly used in women.

Inflatable artificial sphincter: this surgically implanted device is typically used to treat men. An artificial bladder cuff fits around the upper portion of the urethra and replaces the function of the sphincter. It remains in a closed position until the individual manually releases it through a pump accessible in the skin of the scrotum.

If the device is implanted in a woman, the pump is usually placed in the labia.

Factors that affect whether or not surgery is suitable include the patient's age, any plans to have children, lifestyle, overall health, medical history, and the cause of the incontinence.

Medication

Duloxetine is normally used to treat depression, but it may help with stress incontinence.

However, recent studies suggest that it may increase anxiety, depression, and confusion. It may also be less beneficial than surgery in the long term.

Duloxetine can help when used with pelvic floor exercises.

Pelvic floor exercises continue to be the best first option for treatment.

Behavioral changes may help reduce stress incontinence.

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Drinking water can help reduce stress incontinence by preventing constipation.

Changes can range from the timing and amount of daily fluid consumption to lifestyle modifications, such as quitting smoking or losing weight.

Toilet accessibility should be as easy as possible. People who have difficulty moving around might consider special adaptations like a handrail or a raised seat.

Dietary changes: obesity increases the risk of stress incontinence. Losing 5 to 10 percent of body weight may help reduce stress incontinence.

Constipation can place strain on the bladder or supporting muscles. Consuming more fiber and increasing water intake may alleviate this problem.

Reducing the intake of substances that irritate the bladder, such as artificial sweeteners and caffeine may help.

Other possible bladder irritants include:

  • alcohol
  • tobacco
  • chocolate
  • some fruits, such as cranberries, grapes, pineapple, citrus fruits, apples, canteloupe, and plums
  • some vegetables, such as onions, tomatoes, peppers, and chilis
  • milk and dairy products, for example, mature cheese, sour cream, and yogurt
  • rye and soughdough breads
  • seasonings, such as spices, vinegars, walnuts, and peanuts

Avoiding or quitting smoking reduces the likelihood of coughing, and it reduces the risk of bladder cancer.

It can be tempting to reduce fluid intake, but too little fluid can lead to dehydration and a high concentration of waste in the urine. This can irritate the bladder and increase the risk of constipation.

Stress incontinence can be embarrassing, but it is a common problem. Speaking to friends, relatives, or a health specialist may help reduce embarrassment and find a treatment.

Keeping a supply of hygiene equipment, such as pads, can also help.