Stress Incontinence

Stress urinary incontinence (SUI) is a type of incontinence that causes urine (pee) to leak when physical movements put pressure on your bladder. These movements may include exercising, sneezing, coughing, or lifting. Stress incontinence occurs because the muscles that support the bladder and urethra are weakened or damaged. Treatment ranges from symptom management to surgery. 

Normal Urination

The brain and bladder control urination. The bladder stores urine and the pelvic floor muscles hold the bladder in place. The bladder is connected to a tube called the urethra that leads to the outside of the body. 

When the bladder is full, the brain sends a signal telling it to release urine, and urination occurs. The muscles in the bladder contract and the sphincter muscles around the urethra relax and open. Urine is pushed from the bladder and leaves the body by passing through the urethra. 

Types of Urinary Incontinence

Urinary incontinence is sometimes called a bladder control problem. It occurs when a problem in the brain, muscles, or nerves causes urine to leak involuntarily. Types of urinary incontinence include: 

• Urgency (or urge) incontinence: Urgency is characterized by a strong, sudden need to urinate or a need to urinate often. 
• Overflow incontinence: This type of incontinence occurs when the bladder does not completely empty during urination. It causes frequent, constant dribbling of urine. 
• Functional incontinence: A physical or mental impairment keeps a person from making it to the toilet in time. 
• Stress incontinence: Body movements place pressure on the bladder, causing urine to leak. 

Stress Incontinence Symptoms

Stress incontinence symptoms include urine leakage with physical movements such as:

• Coughing or sneezing
• Laughing
• Bending
• Exercising
• Lifting
• Having sex

Causes

Weak or damaged pelvic muscles and nerves make it hard for the bladder and urethra to hold urine. Physical movements place pressure on the bladder causing urine to leak. 

This damage to the nerves and muscles in the pelvic floor may be caused by multiple factors, including:

• Connective tissue disorders
• Menopause 
• Constipation
• Heavy lifting
• Surgery that affects the pelvic floor (such as prostate surgery, hysterectomy, or C-section)
• Obesity
• Smoking (which can lead to lung disease and chronic coughing)
• Injury 
• Pregnancy or childbirth 

Diagnosis

The first step in finding the cause of your urinary leakage is to make an appointment with your primary care doctor. Your doctor will do a physical examination before determining the next steps in your diagnosis.

A Physical Examination

The doctor will ask questions and perform a physical examination that focuses on the urinary, reproductive, and nervous systems.

Bladder Diary

Your doctor may have you start a bladder diary if you aren't keeping one already. A bladder diary helps track daily patterns and symptoms and can help determine if stress incontinence is occurring. The diary should address the following questions:

• How much fluid do you drink throughout the day?
• How often do you go to the bathroom?
• How often is urine leaking?
• How much urine is leaking? 
• What happened immediately before the leaking episode occurred? For instance, were you exercising or did you laugh, cough, or sneeze? 
• Are you using pads, diapers, or absorbent underwear to manage the leakage?

Urine Sample

A urinalysis tests urine for signs of a urinary tract infection or other underlying medical conditions that may cause incontinence. A urinalysis cannot determine if you are experiencing stress incontinence, but it can rule out other causes.

Pad Test

A one-hour pad test is done during an office visit with the doctor, while a 24-hour test is done at home. The pad is weighed after being worn for the designated time period. This gives the doctor information about the amount of urine that is leaking.

Bladder Scan

A bladder scan is an ultrasound test that shows how much urine stays in the bladder after urination. This can tell your doctor if you are experiencing urinary retention, which can be caused by urinary blockages, nerve issues, infections, or certain medications.

Specialist Referral

Your doctor may refer you to a urologist, a doctor who specializes in urinary tract diseases. A urologist may want to perform advanced tests such as a cystoscopy (a procedure that views the inside of the bladder using a thin camera) or urodynamic studies (tests that measure how well the bladder, sphincters, and urethra hold and release urine).

Treatment

Treatment options for stress incontinence vary based on a person’s age, medical history, the root cause, the extent of the problem, and patient input. 

Symptom Management

Symptoms can be managed with absorbent underwear, protective pads, diapers, or waterproof sheets to protect clothing and bedding from urine leakage.

Constipation Prevention

Having regular bowel movements is essential because constipation can make incontinence worse. Prevention of constipation (difficulty eliminating stool) includes eating a diet with plenty of fiber, drinking six to eight glasses of water each day, and exercise.

Bladder Training

Bladder training involves a fixed urination schedule that gradually adds time between bathroom breaks to increase the amount of fluid your bladder can hold.

Pelvic Muscle Training

Pelvic floor muscles are muscles that run from the pubic bone (pubis) to the tailbone (coccyx). They help support the bladder and urethra. Pelvic muscle training or rehabilitation, including the following, improves the muscle tone in the pelvic floor to help prevent leakage:

• Kegel exercises: These exercises strengthen the muscle that supports the pelvis. They work best when performed consistently, usually several times a day.
• Biofeedback: A physical therapist uses a biofeedback instrument in conjunction with Kegel exercises. This helps measure the strength and control of the pelvic muscles.
• Pelvic floor stimulation or E-stim: Therapy that delivers small amounts of electrical stimulation to the pelvic floor muscles. 

Weight Loss

Excess weight is a risk factor for stress incontinence because it places extra pressure on the pelvic floor and bladder.

Specialized Devices

An example of a specialized device used for stress incontinence is a vaginal pessary. It is inserted in the vagina through an applicator to help support the urethra.

Medications

There are currently no medications approved by the Food and Drug Administration used to treat stress incontinence. However, off-label medications such as Proin (phenylpropanolamine) or Cymbalta (duloxetine) may be prescribed.

Vaginal estrogen may be prescribed after menopause to decrease the risk of thinning urethral tissue. Some medications may be used to treat or prevent complications. For example, skin barrier creams protect the skin from breakdown caused by moisture from urinary leakage.

Surgery

Surgical procedures include:

• Sling surgery: Slings are created from a person’s own tissue, donor tissue, or surgical mesh. While the sling placement is different for males and females, the goal for either is to support the urethra. 
• Bladder neck suspension surgery: Sutures (stitches) are placed along the side of the bladder to support the urethra and sphincter muscles. 
• Artificial sphincter surgery: Used for males, it helps keep the urethra closed to prevent leaks.

Injection Therapy

Bulking agents such as collagen are injected around the urethra under a local or general anesthetic.

Prognosis 

Urinary leakage may be an indication of an underlying problem and can cause complications. For example, it can cause skin breakdown and increase the risk of urinary tract infections. However, there are many treatment options, and it is often reversible or curable.

Coping 

Urinary incontinence can cause stress and embarrassment. Those who suffer from it often isolate themselves and avoid social interactions. However, there are many ways to treat and control stress incontinence so you can maintain a high quality of life. 

If you are waiting for a medical appointment or permanent treatment options, here are a few steps you can take now:

• Use pantiliners, pads, diapers, protective underwear, or waterproof sheets to keep clothes and bedding dry. 
• Practice pelvic floor (Kegel) exercises several times a day.
• Schedule trips to the bathroom every few hours. 
• Keep a bladder diary so you and your doctor can identify any patterns. 
• Prevent constipation.

It can also be helpful to share insights from your experiences, as well as learn from others with similar concerns. The National Association for Continence (NAFC) offers message boards that provide a safe place to ask questions anonymously, express frustrations, give support, and share tips.

A Word From Verywell

While discussing incontinence with your doctor may feel awkward, it is a common problem, and it’s important to seek medical advice. Any amount of leakage can be uncomfortable and cause problems such as skin breakdown or urinary tract infections. 

Stress incontinence can decrease your quality of life, especially if you are avoiding normal activities or social interactions due to urine leakage. Check with your doctor to find out which lifestyle changes and treatments may be right for you so you can get back to doing the things you love.