Stress incontinence

Written by Erica Roth
Medically Reviewed by George Krucik, MD

What is Stress Incontinence

Stress incontinence is the unintentional or uncontrollable leakage of urine. In other words, the inability to control your urge to urinate in certain circumstances. It is a serious and embarrassing disorder, which can lead to social isolation. Stress incontinence typically occurs when certain kinds of physical movement puts pressure on your bladder. Laughing, sneezing, coughing, jumping, vigorous exercise, and heavy lifting can all cause stress incontinence. Any pressure placed on the abdomen and bladder can lead to the loss of urine.

It’s important to remember that the term “stress” is used in a strictly physical sense when describing stress incontinence. Emotional stress is not a factor in this type of urinary disorder. The “stress” refers to excessive pressure on the bladder.

An important distinction is that between overactive bladder and stress incontinence. Overactive bladder is a separate condition. In some cases both overactive bladder occurs with stress incontinence and is called mixed incontinence. Your doctor can do tests to determine which one is the cause of your incontinence.

Anatomy of the Bladder

Your bladder is supported by a system of muscles. The sphincter encircles the urethra, the tube that carries urine outside your body. The detrusor is the muscle of the bladder wall and it allows the bladder to expand. The pelvic floor muscles also help support the bladder and the urethra.

To hold urine inside your bladder without leakage, you need to be able to contract your sphincter. When the sphincter and pelvic muscles are weak, it is more difficult to contract these muscles. This can result in stress incontinence.

Who Suffers From Stress Incontinence?

Both men and women can have episodes of stress incontinence. However, according to the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), women are twice as likely as men to suffer from involuntary leakage. (NKUDIC)

The most common causes of stress incontinence among women are pregnancy and childbirth (particularly multiple vaginal deliveries.) During pregnancy and birth, the sphincter and pelvic muscles are stretched out and are weakened. Chronic urinary tract infections can be responsible. Older age and conditions in which the patient has a chronic cough can also cause stress incontinence. This condition can also be an uncomfortable and potentially embarrassing side effect of pelvic surgery. Obesity can also cause this.

Some women only suffer from stress incontinence during the week before they get their period. The NKUDIC explains that estrogen drops during this phase of the menstrual cycle. The lower estrogen levels can weaken the urethra. (NKUDIC) This is not as commonly seen as stress incontinence from other causes.

Among men, prostate enlargement and prostate surgery are common causes of stress incontinence. The prostate gland surrounds the male urethra and its removal can result in loss of support of the urethra. Inflammation of the prostate gland can cause a variety of urinary difficulties, including incontinence.

If the prostate gland is removed, the urethra is no longer well supported. This lack of support may lead to an involuntary leakage of urine. (Mayo Clinic)

Other risk factors for stress incontinence include obesity, constipation, or diabetes.

Stress Incontinence Symptoms

The main symptom of stress incontinence is the loss of bladder control during physical activity.

You may experience a few drops of lost urine or a larger involuntary flow. This can happen while you are exercising, engaging in sexual intercourse, coughing, or sneezing. Sometimes even standing up from a seated or reclining position can put additional pressure on your bladder and cause a leakage.

Stress incontinence is unique for every individual. You may not show symptoms every time you participate in an activity. Also, the same activities that cause leakage for you may not affect another person that has stress incontinence.

Treatment for Stress Incontinence

Treatment for stress incontinence varies according to the underlying cause of your problem. Your doctor will usually help you to manage the condition with a combination of medical treatment and lifestyle adjustments.

Behavioral Therapy

Behavioral therapy means changing the way you live to reduce the episodes of stress incontinence. If you are obese, your doctor may advise you to lose weight. You might also try to avoid the activities, such as jumping or jogging, that cause leakage.

If you are a smoker, you should quit since nicotine can irritate the bladder and may contribute to your problem. You should also avoid caffeine and alcohol, because these beverages are bladder irritants. You might want to cut back on your overall fluid intake to reduce bladder pressure. The constant cough seen in smokers also contributes to the problem of stress incontinence.

Pelvic Muscle Training

For many women, pelvic muscle training (pelvic floor muscle exercises) can help treat stress incontinence. Kegel exercises make your sphincter and pelvic muscles stronger. To perform a Kegel, contract the muscles you use to stop the stream of urine when you urinate.

You might want to do Kegels while sitting on the toilet to help you learn which muscles to use. Once you have mastered the exercise, you can perform them anywhere and at any time.

Let your doctor know if you have a hard time learning Kegel exercises. According to the National Institutes of Health, you might be a candidate for biofeedback therapy instead. (NIH)

Biofeedback therapy is a treatment which uses instruments to help you to recognize the stimuli which lead to certain responses in your body and to modify them. In the treatment of urinary incontinence these instruments measure the contraction of the muscles in your bladder.

Electrical stimulation is a treatment that sends a mild electrical current to the pelvic floor muscles. The current makes the muscles contract, mimicking a Kegel exercise. You may be able to contract the muscles yourself after feeling exactly which muscles are contracting.

Medication

There are several medications that are very effective in treating patients with stress incontinence. The NIH states that imipramine, an antidepressant drug, can be effective as a treatment method. (NIH) Anticholinergic medications calm the bladder contractions that can also cause stress incontinence.

Surgery

If you have a severe case of stress incontinence, to the point that it interferes with your everyday life, your doctor may recommend surgery. Several types of procedures are available and include vaginal repairs and other procedures to lift the bladder and urethra. These surgeries are being perfected on an ongoing basis and a qualified surgeon can explain your many options.

During the surgery, doctors will try to provide your urethra and bladder with more support. A sling procedure uses your own tissues to create a support structure for the urethra. The Mayo Clinic states that slings are used more often in women than in men. (Mayo Clinic)

Your urologist—a doctor who specializes in the urinary tract—may also choose to inject collagen directly into the supportive tissues of your urethra. The collagen strengthens the sphincter muscle by increasing the pressure on the urethra. Collagen injection is the least invasive surgical procedure to treat stress incontinence.

Stress incontinence is a treatable disorder. There is no need to suffer the embarrassing consequences of incontinence in silence.

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