This article will discuss what stress incontinence is and how it can be managed.
What is stress incontinence?
The most common cause of urination when coughing is the weakening of muscles around the bladder due to sudden action.
Stress incontinence is the most common type of urinary incontinence, which occurs when the muscles that prevent urination are weakened by an action, such as a cough.
Urine is produced by the kidneys and stored in the bladder. The muscles surrounding the bladder help to keep urine in by tightening the urethra through which urine will eventually pass.
Once the bladder is full, the muscles surrounding the bladder contract and the urethra relaxes to allow the release of urine from the body.
Actions, such as coughing, can cause a sudden physical pressure on the bladder. This pressure can cause the pelvic floor muscles to relax suddenly.
The pelvic floor muscles are under the urethra. They support the bladder in keeping the urethra closed to stop its content from leaking out.
By causing the pelvic floor muscles to relax momentarily, a cough can cause urine to leak through the urethra and out of the body.
The only symptom of stress incontinence is the involuntary passing of urine from sudden actions that put pressure on the bladder, such as coughing.
Causes of stress incontinence
Urine leaking can occur from sudden jolts to the body, such as those that occur when coughing, sneezing, or laughing. It can also occur, as a result of physical movements, such as when:
- lifting heavy objects
- having sexual intercourse
It is possible for the pelvic floor muscles or the muscles surrounding the urethra to be damaged or weakened from the following:
- giving birth
- certain medications
Drinking too much alcohol, or drinks containing caffeine, may increase the risk of stress incontinence.
Stress incontinence is much more common in females than in males, affecting 1 in 3 women in their lifetimes.
It is also more likely to develop when a person is 40 years of age or more, making older females the highest risk group.
Other risk factors for stress incontinence include:
- long-term coughing
- consuming too much alcohol or caffeine
- previous surgery in the region of the pelvis
Some of these risk factors can be avoided, and by doing so, a person can reduce their risk of developing stress incontinence.
Urinary incontinence can make a person feel embarrassed. Nevertheless, it is important for people to seek professional help for this common condition.
If urinary incontinence is suspected, a doctor may ask someone to keep a diary of urination habits to determine likely causes of the problem.
The doctor may also carry out a physical examination of the abdomen and genitals or a neurological exam, focusing on pelvic nerve problems. A urine sample could be required to test for infection.
In rare cases, it may be necessary to test how the bladder is working. This can involve a range of procedures, such as inserting an endoscope into the urinary system. An endoscope is a flexible tube with a light and a camera, which a doctor uses to identify problems inside the body.
There are several ways of treating stress incontinence if someone finds they leak urine when they cough.
Stretches and exercises that strengthen the pelvic floor muscles may help to treat stress incontinence.
Strengthening the pelvic floor muscles is the most common non-surgical method of treating stress incontinence.
A specialist or physiotherapist can advise on exercise programs that target the pelvic floor muscles.
Exercises usually consist of contracting the pelvic muscles. It is recommended to include a minimum of 15 to 20 pelvic muscle contractions three times a day over the course of several months.
Other muscle-strengthening techniques
If someone cannot contract their pelvic floor muscles, or if extra support is necessary, then other approaches to help strengthen the muscles may be included in treatment.
These additional techniques can include:
- Electrical stimulation: Strengthening the pelvic muscles by making them contract, using electrical stimulation.
- Vaginal cones: Small weights are inserted into the vagina for 10-20 minutes. The pelvis muscles will naturally hold the cone in place and will become stronger, as the weights are progressively increased.
- Biofeedback: A small probe or electrode can be used to monitor how well the pelvic muscles are being squeezed. The resulting feedback can help people to improve their exercise technique or complete exercises more effectively.
Treatment could also include some lifestyle changes to reduce the risk factors linked to stress incontinence. Changes that may help include:
- Losing weight: If a person is overweight, this can help to reduce the undue pressure on the bladder.
- Changing drinking habits: Drinking too much or too little can make the problem worse. Drinking alcohol or caffeine can also make symptoms worse.
- Smoking: It can help to cut down on smoking in order to reduce coughing.
If pelvic floor muscles are not being strengthened, surgery could be another option. Surgery will typically aim to tighten or support muscles below the bladder.
Several medications can treat stress incontinence, including the antidepressant duloxetine, adrenergic stimulators or blockers, tricyclic antidepressants, and hormones. These may be used if other therapies do not work or someone wishes to avoid surgery.
Duloxetine can help urethra muscles to contract better, helping to manage the symptoms or enhance other treatments.
Side effects can occur when taking duloxetine. These include:
Treating stress incontinence successfully can be variable, and the results will depend on the individual.
Typically, strengthening the pelvic floor muscles is an effective strategy in treating the condition, and this will be enough to stop urine leaking when a person coughs.
In some cases, however, more intense interventions, including surgery and medication, can be required.