Urinary incontinence is the medical term for the involuntary leakage of urine from the bladder.
Stress incontinence is a type of urinary incontinence in which physical pressure forces urine to leak out of the bladder. This pressure may come from exercise or forceful actions, such as coughing or sneezing.
In this article, we discuss stress incontinence in more detail, including its symptoms and causes. We also describe some of the ways in which doctors might diagnose and treat stress incontinence.
The bladder and urethra make up part of the urinary system. The bladder stores urine, and the urethra is the tube that drains urine from the bladder during urination. When a person is not urinating, urinary sphincter muscles at the top of the urethra create a tight seal around the opening of the bladder to prevent urine from leaking out.
Stress incontinence occurs when any sudden pressure on the urethra or bladder causes the urethral sphincters to open briefly, allowing urine to leak out of the bladder.
The level of activity necessary to cause leaks can vary. In mild cases, the bladder may only leak urine during forceful activities, such as:
In more severe cases, a person may experience leakage during less forceful movements, such as:
- bending over
The primary symptom of stress incontinence is urine leakage during activity. The amount of urine that the bladder leaks can vary, ranging from only a few drops to a quantity capable of soaking through a person’s clothing.
According to the National Association for Continence (NAC), some activities that may trigger urine leakage include:
- having sexual intercourse
- lifting heavy objects
- getting out of a car or standing up
The American Urological Association (AUA) note that a person who has stress incontinence does not experience symptoms associated with other types of urinary incontinence. For example, a person does not feel an urgent or uncontrollable need to urinate as they would if they had an overactive bladder.
According to the AUA, stress incontinence may occur as a result of stretching or otherwise damaging the pelvic floor muscles that support the bladder and urethra. This damage could occur as a result of the following:
The following factors may increase a person’s risk of developing stress incontinence:
- being biologically female
- pregnancy and childbirth
- natural aging
- having overweight or obesity
- having an anatomical predisposition to the condition
Although stress incontinence is not likely to cause major health complications, it can have a significant effect on a person’s quality of life. According to the NAC, people with stress incontinence may experience the following:
Urine leakage causes moisture to accumulate on the skin on and around the genitals. This moisture buildup can lead to localized skin inflammation and irritation.
Urine leakage may cause people to feel embarrassed or anxious about socializing with others. People who avoid socializing may go on to experience social isolation and depression.
Any amount of urine leakage is not normal. As such, a person should see their doctor even if they experience only a few small drops of urine leakage.
The diagnostic procedure for stress incontinence typically consists of the following:
- a review of the person’s medical history to check for possible causes, such as:
- recent surgeries
- preexisting lung disorders
- a physical examination
- a pad test, which involves wearing an absorbent pad for 1 or 24 hours so that a doctor can determine the amount of urine leakage within a given period
If the doctor is still unable to determine the cause of the urine leakage, they may order one or more of the following tests:
- Urinalysis: A urine sample test that detects the presence of blood or infection.
- Bladder scan: A medical imaging test to show how much urine remains in the bladder after a person has finished urinating.
- Cystoscopy: A procedure that allows a doctor to see into the bladder using a tube with a tiny camera attached.
The treatment for stress incontinence may consist of a combination of at-home treatments and medical treatments.
The AUA recommend that a person try one or more of the following lifestyle changes to help control urinary leakage:
- eating a diet rich in fiber to prevent pressure from constipation
- quitting smoking to prevent pressure from chronic coughing
- reaching or maintaining a moderate weight
- performing pelvic floor exercises to strengthen the muscles that support the bladder
A person can also talk to their doctor about bladder training. This process involves the person recording when they drink, urinate, and leak before setting a schedule to urinate less frequently.
People may also choose to wear pads to help absorb urine leaks and prevent localized skin irritation.
If at-home treatments do not alleviate stress incontinence, a doctor may recommend using a device to help prevent urine leakage. Some examples include:
- Nondisposable pessaries: Custom-fit rings that a doctor places into the vagina to help support the bladder and urethra.
- Disposable pessaries: Over-the-counter (OTC) disposable pessaries that a person can place into the vagina for up to 8 hours in a 24-hour period to help support the bladder and urethra.
- Penile clamp: A device that applies gentle pressure to the end of the penis and urethra to help prevent urine leakage during daily activities.
Doctors may sometimes recommend surgery to treat stress incontinence. Several different surgical options are available, and a person should talk to their doctor to find out which will be most suitable for them. Some possibilities include:
- Urethral injection: An injection that uses bulking agents to increase the size of the urinary sphincter muscles. This expansion helps the sphincter close off the bladder opening more effectively.
- Sling surgery: A procedure that places a small strip of material beneath the urethra to help stabilize and support it during activities.
- Bladder neck suspension: This procedure attaches the bladder neck and urethra to a ligament that runs along the pubic bone. This attachment helps prevent the bladder and urethra from moving downward and accidentally opening during activity.
- Artificial sphincter: A procedure that allows males to control their bladder emptying. It involves inserting a device that consists of the following three parts:
- a fluid filled cuff that acts as an artificial sphincter around the urethra
- a fluid filled balloon inside the abdomen, which helps regulate pressure in the bladder
- a pump inside the scrotum that a person can manipulate to control their bladder emptying
A person should see a doctor if they experience any amount of urine leakage. Even mild urine leakage could signal an underlying health condition that requires diagnosis and appropriate treatment.
Stress incontinence is a type of urinary incontinence in which the bladder leaks urine during activity. The amount of urine that the bladder leaks can range from a few drops to a quantity large enough to soak a person’s clothing.
Mild stress incontinence involves urine leakage during forceful activities, such as exercising or weightlifting. Severe stress incontinence involves urine leakage during less forceful activities, such as bending over, walking, or standing. Either kind warrants medical attention.
Certain lifestyle changes may help reduce bladder leakage. Examples include maintaining a moderate weight and performing exercises to strengthen the pelvic floor muscles. If these do not help, a person should talk to their doctor about additional treatment options.