Stress incontinence is urine leakage due to pressure on the bladder, which may occur with sneezing, coughing, laughing, or exercise. It commonly occurs in older females.

Stress incontinence affects twice as many females as males, mainly due to life events such as pregnancy, childbirth, and menopause. These events can affect the bladder, urethra, and supporting muscles.

The condition is a type of urinary incontinence common in older females, although it can happen at any age. More than 4 in 10 females aged 65 and older have urinary incontinence.

This article discusses the causes and symptoms of stress incontinence in females. It also examines diagnosis, treatment, and lifestyle choices that may help.

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Stress incontinence may occur if the pelvic floor muscles cannot support normal bladder function effectively. This loss of support may occur due to the following:

If any previous pelvic surgery has led to neuromuscular damage, this may also cause stress incontinence.

With stress incontinence, any sudden pressure on the bladder may cause urine to leak out. Any forceful activity, such as sneezing, can cause the muscles that control urine flow to release briefly.

A person can leak urine during activities that put pressure on the bladder, such as:

  • coughing
  • sneezing
  • laughing
  • heavy lifting
  • straining
  • exercising
  • having sex
  • getting in and out of a car

In more severe cases of stress incontinence, urine may leak with gentler activities, such as walking, standing up, or bending over.

The level of activity that causes urine leakage depends on how severe a person’s stress incontinence is.

The amount of urine leakage can vary for each person and may range from a few drops of urine to a tablespoon or more or enough urine to soak through clothes.

Stress incontinence can negatively affect quality of life, so people should contact a doctor if they have symptoms.

Before or during diagnosis, it may be helpful for people to keep a bladder diary to track the following:

  • daily symptoms
  • how much fluid they drink each day
  • how often they need to use the bathroom
  • when leaks occur, and what people were doing at the time, such as coughing, sneezing, or running

Noting down daily symptoms will help a doctor in their diagnosis. A doctor will also take a full medical history, which may include questions about diet, lifestyle, and medications the person is taking.

A doctor will perform a physical exam of the pelvic area and may test the strength of the pelvic floor muscles or whether urine leaks during certain activities, such as bending over.

People may have a pad test, in which they wear a urinary pad for a set amount of time to measure how much urine leaks. This can be for 1 hour in the doctor’s office or 24 hours at home.

Additional tests for stress incontinence may include:

  • urine test to check for blood in the urine or a urinary tract infection
  • bladder scan, which shows how much urine remains in the bladder after urinating
  • cystoscopy, which involves inserting a thin tube with a camera into the bladder to help rule out any other conditions
  • urodynamic studies, which test how effectively the bladder, urethra, and sphincter muscles are working to control urine flow

Stress incontinence is common but not a normal part of aging. There are many treatments that effectively treat or manage the condition.

Treatment options include:

  • exercises to strengthen the pelvic floor muscles, such as Kegel exercises
  • bladder training, in which a person follows a regular schedule of using the bathroom to help leave the bladder emptier for longer
  • biofeedback to help a person regain control over the pelvic floor muscles
  • electrostimulation, which delivers a mild electrical current to target nerves affecting urination
  • pessaries to help support the urethra
  • medications, such as oxybutynin to block muscle contractions relating to urine flow, or tricyclic antidepressants, which affect how the urethra closes and contracts
  • topical estrogen to increase blood flow in the urethra, particularly for menopausal females

If other treatments are ineffective, surgery may be an option. Surgical treatment may include:

  • Urethral injections: These involve injecting bulking agents into the urethra to help the sphincter muscle keep the bladder closed.
  • Sling surgery: This involves placing a strip of synthetic mesh or a person’s own tissue under the urethra to support it during activity.
  • Bladder neck suspension: This uses stitches to attach the area where the bladder and urethra join to a ligament of the pubic bone, helping prevent urine leakage during activity.

Depending on the type of surgery, a person may require a local or general anesthetic.

Stress incontinence may negatively affect a person’s quality of life and can have emotional, mental, and physical effects. Possible complications of stress incontinence include:

  • Isolation and loneliness: People can feel embarrassed or ashamed about their condition and fear having urine leaks in public. They may avoid socializing with others.
  • Depression: This may occur from restricting normal activities and the psychological effects of living with stress incontinence.
  • Sore skin: People may develop irritated or sore skin from urine leaks.

Complications from treatment may include medication side effects or risks from surgery, such as infection.

Making lifestyle changes may help to treat stress incontinence. These include:

  • Aiming for regular bowel movements: Constipation may worsen incontinence. To avoid it, people can eat a diet high in fiber, exercise daily, and drink 6–8 glasses of water daily.
  • Avoiding or quitting smoking: Smoking increases strain on the pelvic floor muscles and may increase the likelihood of leaks due to chronic coughing.
  • Maintaining a healthy weight: Excess weight can put more pressure on the bladder and pelvic floor muscles.
  • Practicing pilates: Pilates exercises can improve pelvic floor strength and reduce stress incontinence.

It may help to avoid certain foods and drinks that can irritate the bladder, including:

  • caffeinated drinks, such as coffee, tea, and sodas
  • alcohol
  • chocolate
  • spicy foods
  • tomato
  • citrus fruits

People can try the following home remedies for stress incontinence:

  • Wear absorbent pads or underwear to absorb excess urine. This may be helpful while other treatments take effect.
  • Perform sets of Kegel exercises daily.
  • Use a barrier cream to prevent urine leaks from irritating the skin.

Find 10 tips for managing a weak bladder here.

Treatment for stress incontinence aims to improve quality of life and reduce the severity of urine leaks. In some cases, treatment may cure stress incontinence. Pelvic floor exercises over 12 months may cure stress incontinence in over half of cases.

According to the American Urological Association, surgery is usually very successful, particularly when a person combines it with lifestyle changes. Surgical treatment may greatly improve or cure stress incontinence.

Stress incontinence is urine leakage during activities that put pressure on the bladder, such as sneezing, coughing, or exercising.

Health events unique to females, such as pregnancy and menopause, make the condition more common in females than males.

Treatments include lifestyle changes, pelvic floor exercises, behavioral therapies, and surgery.