Coughing, laughing, running — all can lead to accidental urine leakage if you have stress incontinence. Learn about treatment options and self-care.
Urinary incontinence is the unintentional loss of urine. Stress incontinence happens when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine. Stress incontinence is not related to psychological stress.
Stress incontinence is different from urgency incontinence and overactive bladder (OAB). If you have urgency incontinence or OAB, your bladder muscle contracts, causing a sudden urge to urinate before you can get to the bathroom. Stress incontinence is much more common in women than in men.
If you have stress incontinence, you may feel embarrassed, isolate yourself, or limit your work and social life. You may also avoid physical and leisure activities. With treatment, you'll likely be able to manage stress incontinence and improve your overall well-being.
Your urinary system includes the kidneys, ureters, bladder and urethra. The urinary system removes waste from the body through urine. The kidneys are located toward the back of the upper abdomen. They filter waste and fluid from the blood and produce urine. Urine moves from the kidneys through narrow tubes to the bladder. These tubes are called the ureters. The bladder stores urine until it's time to urinate. Urine leaves the body through another small tube called the urethra.
If you have stress incontinence, you may leak urine when you:
You may not leak urine every time you do one of these things. But, any activity that puts pressure on your bladder can make involuntary urine loss more likely, particularly when your bladder is full.
Talk to your health care provider if your symptoms bother you or interfere with daily activities, such as your work, hobbies and social life.
Stress incontinence occurs when the muscles and other tissues that support the urethra (pelvic floor muscles) and the muscles that control the release of urine (urinary sphincter) weaken.
The bladder expands as it fills with urine. Typically, valve-like muscles in the urethra — the short tube that carries urine out of your body — stay closed as the bladder expands, preventing urine leakage until you reach a bathroom. But when those muscles weaken, anything that exerts force on the abdominal and pelvic muscles — sneezing, bending over, lifting or laughing hard, for instance — can put pressure on your bladder and cause urine leakage.
Your pelvic floor muscles and urinary sphincter may lose strength because of:
Other factors that may worsen stress incontinence include:
The female pelvic floor muscles support the pelvic organs, including the uterus, bladder and rectum. Kegel exercises can help strengthen these muscles.
Factors that increase the risk of developing stress incontinence include:
Complications of stress incontinence may include:
During your visit, your health care provider looks for clues that may indicate contributing factors. Your appointment will likely include a:
Common cases of urinary incontinence usually don't require additional tests. However, in some cases, your provider might order tests to assess how well your bladder, urethra and sphincter are functioning (urodynamic tests).
Bladder function tests may include:
Measurements of post-void residual urine. Your provider may recommend this test if there's concern about your ability to empty your bladder completely, particularly if you are older, have had prior bladder surgery or have diabetes. This test can tell how well your bladder is functioning.
A specialist uses an ultrasound scan, which translates sound waves into an image, to view how much urine is left in your bladder after you urinate. In some cases, a thin tube (catheter) is passed through the urethra and into your bladder. The catheter drains the remaining urine, which can then be measured.
Measuring bladder pressures. Cystometry is a test that measures pressure in your bladder and in the surrounding region as your bladder fills. Your provider may recommend this test to check for stress incontinence if you have had a neurologic disease of the spinal cord.
A catheter is used to fill your bladder slowly with warm fluid. As your bladder fills, you may be asked to cough or bear down to test for leaks. This procedure may be combined with a pressure-flow study, which tells how much pressure your bladder has to exert in order to empty completely.
You and your provider should discuss the results of any tests and decide how they impact your treatment strategy.
Your health care provider may recommend a combination of strategies to treat incontinence. If an underlying cause or contributing factor, such as a urinary tract infection, is identified, you'll also receive treatment for the condition.
Behavior therapies may help you eliminate or lessen episodes of stress incontinence. The treatments your doctor recommends may include:
Pelvic floor muscle exercises. Your provider or physical therapist can help you learn how to do Kegel exercises to strengthen your pelvic floor muscles and urinary sphincter. Just like any other exercise routine, how well Kegel exercises work for you depends on whether you perform them regularly.
A technique called biofeedback can be used along with Kegel exercises to make them more effective. Biofeedback involves the use of pressure sensors or electrical stimulation to reinforce the proper muscle contractions.
Fluid consumption. Your provider may recommend how much and when you should consume fluids during the day and evening. However, don't limit what you drink so much that you become dehydrated.
Your provider may also suggest that you avoid caffeinated, carbonated and alcoholic beverages, which may irritate and affect bladder function in some people. If you find that using fluid schedules and avoiding certain beverages significantly improve leakage, you'll have to decide whether making these changes in your diet are worth it.
There are no approved medications to specifically treat stress incontinence in the United States. The antidepressant duloxetine (Cymbalta, Drizalma Sprinkle) is used for the treatment of stress incontinence in Europe, however.
Symptoms quickly return when the drug is stopped. Nausea is the most common side effect that makes people stop taking the medication.
Certain devices designed for women may help control stress incontinence, including:
Vaginal pessary. A specialized urinary incontinence pessary, shaped like a ring with two bumps that sit on each side of the urethra, is fitted and put into place by your provider. It helps support your bladder base to prevent urine leakage during activity, especially if your bladder has dropped (prolapsed).
This is a good choice if you wish to avoid surgery. A pessary will require routine removal and cleaning. Pessaries are used mostly in people who also have pelvic organ prolapse.
Urethral inserts. This small tampon-like disposable device inserted into the urethra acts as a barrier to prevent leakage. It's usually used to prevent incontinence during a specific activity, but it may be worn throughout the day.
Urethral inserts can be worn for up to eight hours a day. Urethral inserts are generally used only for heavy activity, such as repeated lifting, running or playing tennis.
Surgical interventions to treat stress incontinence are designed to improve closure of the sphincter or support the bladder neck. Surgical options include:
Sling procedure. This is the most common procedure performed in women with stress urinary incontinence. In this procedure, the surgeon uses the person's own tissue, synthetic material (mesh), or animal or donor tissue to create a sling or hammock that supports the urethra.
Slings are also used for men with mild stress incontinence. The technique may ease symptoms of stress incontinence in some men.
The Burch procedure, the most common suspension surgery, adds support to the bladder neck and urethra, reducing the risk of stress incontinence. In this version of the procedure, surgery involves placing sutures in vaginal tissue near the neck of the bladder — where the bladder and urethra meet — and attaching them to ligaments near the pubic bone.
Healthy lifestyle practices can ease symptoms of stress incontinence. These include:
Treatments for stress incontinence can often substantially reduce, and possibly eliminate, urine leakage. Some people will still have urine leakage every now and then. Being prepared may help you cope.
Maintaining your connection with family, friends and co-workers can prevent feelings of isolation and depression that can accompany incontinence. Being prepared may help you feel more comfortable when you're out and about:
Leaking urine during sexual intercourse can be upsetting, but it doesn't necessarily have to get in the way of intimacy and enjoyment:
Incontinence is not a normal part of aging. Treatments are usually available to cure or significantly reduce the effects of stress incontinence on your life.
Find a health care provider who's willing to work with you to determine the best way to treat your incontinence. Choosing the right treatments for you should be a partnership between you and your provider. Take time to discuss the pros and cons of the many treatment options with your provider.
Consider joining a support group. Support groups offer an opportunity to voice concerns and often provide motivation to maintain self-care strategies.
Organizations such as the National Association for Continence offer resources and information for people who have stress incontinence.
Your health care provider may have you fill out a questionnaire to make a preliminary assessment of your stress incontinence symptoms. You may also be asked to keep a bladder diary for a few days. In a bladder diary, you record when, how much and what kind of fluids you consume, as well as when and how much you urinate and when you experience incontinence episodes.
Your diary may reveal patterns that help your provider understand your symptoms and identify contributing factors. This may reduce the need for more invasive testing.
Specialized testing may require referral to a specialist in urinary disorders for men and women (urologist) or a specialist in urinary disorders in women (urogynecologist).
To get the most from your visit to your health care provider, prepare in advance:
For urinary incontinence, some basic questions to ask your provider include:
Don't hesitate to ask other questions as they occur to you during your appointment.
Be prepared to answer questions from your provider. Questions your provider might ask include: