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What is female urinary stress incontinence?

Female urinary stress incontinence is the involuntary release of urine during any physical activity that puts pressure on your bladder. It’s not the same as general incontinence. This potentially uncomfortable condition only happens when the bladder is under immediate physical stress. Activities that can put stress on your bladder include:

  • coughing
  • sneezing
  • laughing
  • lifting heavy objects or straining
  • bending over

Female urinary stress incontinence occurs when your pelvic muscles weaken. These muscles form a bowl that lines your pelvis. They support your bladder and control the release of your urine. As you age these pelvic muscles grow weak. Childbirth, pelvic surgery, and injury to your pelvis can weaken the muscles. Increased age and a history of pregnancy are also big risk factors.

Stress incontinence is far more common among women than men. It can occur at any age. But the chances of developing stress incontinence increases with pregnancy and as you age.

According to the American Academy of Physicians (AAP), about 50 percent of women between the ages of 40 to 60, and nearly 75 percent of women over the age of 75, have some form of urinary incontinence (UI). The actual figures may be even higher, since the condition is underreported and under diagnosed, according to the AAP. It estimates that about one-half of the women who experience UI do not report it to their doctors.

Certain factors can increase the risk of female urinary stress incontinence, or can aggravate symptoms if you already have it.

Food and drinks

The following may make your stress incontinence worse due to bladder irritation:

  • alcohol
  • caffeine
  • soda
  • chocolate
  • artificial sweeteners
  • tobacco or cigarettes

Overall health

The following health factors may make your stress incontinence worse:

  • urinary tract infections
  • obesity
  • frequent coughing
  • medications that increase urine production
  • nerve damage or excessive urination from diabetes

Lack of treatment

Female urinary stress incontinence is usually treatable. But many women rarely seek help. Don’t let embarrassment stop you from seeing your doctor. Female urinary stress incontinence is common. Your doctor has most likely encountered it many times in other patients.

To make a diagnosis, your doctor will likely perform a pelvic exam in addition to one or more of the following tests:

  • Urinary stress test: Your doctor will ask you to cough while you’re standing to see if you involuntarily leak urine.
  • Pad test: You will be asked to wear a sanitary pad during exercise to see how much urine you leak.
  • Urinalysis: This test enables your doctor to determine if you have certain abnormalities in your urine like blood, protein, sugar, or signs of infection.
  • Post-void residual (PVR) test: Your doctor will measure how much urine is in your bladder after you have emptied it.
  • Cystometry test: This test measures pressure in your bladder and your flow of urine.
  • X-rays with contrast dye: Your doctor will be able to spot abnormalities in your urinary tract.
  • Cystoscopy: This test uses a camera to look inside your bladder for signs of inflammation, stones, or other abnormalities.

Several types of treatment are available. Treatment options include:

  • lifestyle changes
  • medications
  • nonsurgical treatments
  • surgery

Lifestyle changes

Make regular trips to the restroom to reduce the chance of urine leakage. Your doctor may also suggest you avoid caffeine and exercise regularly. Dietary changes may also be in order. If you smoke you’ll likely be advised to quit. Losing weight can also help take pressure off your stomach, bladder, and pelvic organs. Your doctor may also develop a weight-loss plan if you’re overweight.


Your doctor may prescribe medications that reduce bladder contractions. These include drugs such as:

  • Imipramine
  • Duloxetine

Your doctor may also prescribe mediation designed to treat an overactive bladder, such as:

  • Vesicare
  • Enablex
  • Detrol
  • Ditropan

Nonsurgical treatments

Kegel exercises and pelvic floor muscle therapy

Kegel exercises may help strengthen your pelvic muscles. To do these exercises, squeeze the muscles that stop the flow of urine. Your doctor will show you the right way to do these exercises. However, it’s unclear how many Kegels should be done, how often, or even how effective they can be. Some research has shown that doing Kegel exercises during and after pregnancy may reduce your chances of developing urinary stress incontinence.

Pelvic floor muscle therapy is another effective method to help alleviate stress incontinence. This can be done with the aid of a physical therapist, trained specifically in pelvic floor exercises. An increase in overall physical activity has been shown to strengthen the pelvic floor. Yoga and Pilates are known to be helpful.


Biofeedback is a type of therapy that is used to increase awareness of your pelvic floor muscles. The therapy uses small sensors that are placed inside or around your vagina and on your abdomen. Your doctor will have you try certain muscle movements. The sensors record your muscle activity to help you identify the specific muscles of the pelvic floor. This can help identify exercises to help strengthen your pelvic floor and improve bladder function.

Vaginal pessary

This procedure requires a small ring be placed inside your vagina. It will support your bladder and compress your urethra. Your doctor will fit you with the correct size vaginal pessary and will show you how to remove it for cleanings.


Your doctor may recommend surgery if other treatments fail. Types of surgery include:

Injectable therapy

Doctors inject bulking agent into your urethra to thicken the area in order to reduce incontinence.

Tension-free vaginal tape (TVT)

Doctors place a mesh around your urethra to give it support.

Vaginal sling

Doctors place a sling around your urethra to provide more support for it.

Anterior or paravaginal vaginal repair (also called a cystocele repair)

This surgery repairs a bladder that is bulging into the vaginal canal.

Retropubic suspension

This surgery moves the bladder and urethra back into their normal positions

Stress incontinence is very common among women over the age of 40. Treatments available include lifestyle changes, medications, nonsurgical treatments, and surgery. These treatments rarely cure stress incontinence. But they can reduce symptoms and improve quality of life.