First-line treatment for stress incontinence may include lifestyle changes, behavioral therapy, or pelvic floor exercises. Severe cases may require special devices or surgery.
Stress incontinence is a form of urinary incontinence. It refers to the unintentional leakage of urine during activities that place pressure on your bladder.
Everyday occurrences like coughing, sneezing, or laughing can cause urinary leakage. Brisk walking, running, lifting heavy objects, and other physical movements can also cause urine leakage in people with this condition.
Stress incontinence is linked to having weak pelvic floor muscles. The condition becomes common as people age. It’s most common in people assigned female at birth, but people assigned male at birth can also have it.
Certain lifestyle changes may help with stress incontinence. If those fail, there are medical treatments available.
Language matters
You’ll notice that the language used to share stats and other data points is pretty binary, fluctuating between the use of “male” and “female” or “men” and “women.”
Although we typically avoid language like this, specificity is key when reporting on research participants and clinical findings.
Unfortunately, the studies and surveys referenced in this article didn’t report data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.
You can make behavioral changes to reduce urinary leakage from stress incontinence. Many of these aim to improve your pelvic floor muscle tone or reduce pressure on your bladder.
- Increased physical activity: Exercise improves muscle tone, and activities like yoga and Pilates can improve your pelvic floor health. Aerobic activities can help you maintain a moderate weight, which can reduce bladder pressure.
- Avoiding smoking: Smoking can irritate your bladder and cause chronic coughing, which can trigger stress incontinence symptoms.
- Weight loss: Excess weight places pressure on your abdomen and bladder, increasing your risk of urinary leakage.
Research from 2018 suggests that weight loss can help with stress incontinence but usually not in the long term. - Dietary changes: Avoid foods and beverages that irritate your bladder.
When to get medical help
Stress incontinence isn’t the result of stress. Still, it can cause anxiety and stress. If you’re experiencing leakage regularly, a doctor or healthcare professional may be able to recommend treatments that can relieve your symptoms and improve your day-to-day life.
It’s also important to speak with a healthcare professional if your symptoms include pain during urination or blood in your urine.
Behavioral therapies aim to change your urinary voiding habits and behaviors. They also help you learn skills that reduce urine leakage. Such therapies include:
Bladder training
Bladder training can help treat symptoms of overactive bladder (OAB) and stress incontinence. Bladder training can help you adjust and control your toilet behaviors and establish a schedule that works for you.
Through bladder training, you learn how to hold your bladder for longer intervals between bathroom visits. It may also involve keeping a bladder diary, which can help you identify how often you urinate and when accidents are more likely to occur.
Biofeedback
Biofeedback sessions take place in a lab or medical setting. Healthcare professionals record your bladder, rectal sphincter, and abdominal pressures and display them on a screen for you to view. This helps you learn and practice muscle relaxation and contraction techniques.
Strengthening your pelvic floor is a key component of bladder control training, regardless of your sex assigned at birth.
Targeted pelvic floor exercises (aka Kegels or clench-and-release exercises) strengthen the muscles that support your bladder, reducing or eliminating leaks. You can do Kegel exercises at any time throughout the day.
In electrical stimulation, electrodes placed in your leg, vagina, or anus transmit a mild electric current to the nerves involved in urination. In some cases, you can perform this at home.
Although electrical stimulation is an established treatment for many types of incontinence, there’s not a lot of research into how well it treats stress incontinence. A
A doctor may recommend surgery if your symptoms are moderate to severe and don’t improve with lifestyle changes or conservative treatments.
Surgical procedures for stress incontinence aim to improve the ability of your sphincter muscle to close, preventing leakage. Surgery may also strengthen and support your urethra, the tube through which urine travels. The most common surgeries doctors use to treat stress incontinence are:
- Bladder suspension surgery: Also known as a bladder lift or colposuspension, this fixes sagging in your urethra or bladder that may be causing leakage.
- Urethral sling: A surgeon takes some of your own tissue (or uses a synthetic material) to make a sling that supports your urethra.
Can any medications help with stress incontinence?
There are currently no approved medications to treat stress incontinence in the United States.
In some European countries, doctors use duloxetine (Cymbalta), an antidepressant, to relieve symptoms. But duloxetine isn’t a cure for stress incontinence.
Stress incontinence is more common in people assigned female at birth than in those assigned male. Treatments specifically designed for this population include:
Vaginal estrogen
Stress incontinence and OAB may start to occur during perimenopause or menopause. Vaginal estrogen cream, a type of hormone replacement therapy (HRT), may help relieve bladder weakness and vaginal dryness.
Vaginal pessaries
A pessary is a fitted, ring-like device you insert into your vagina, like a diaphragm. A well-fitting pessary will press firmly against your vaginal wall and urethra. Pessaries reduce urinary leakage by physically supporting your bladder.
You can leave a pessary inside your vagina for up to a week or remove it nightly for cleaning.
Urethral injections
A healthcare professional may inject a bulking agent, such as a gel, into the area around your upper urethra. This helps your sphincter muscle close tightly so urine won’t leak out.
Stress incontinence is less common in people assigned male at birth. It can sometimes result from surgery to treat prostate cancer or remove benign tumors. Stress incontinence treatments specific to this population include:
Condom catheters
A condom catheter is a urine collection device that fits over your penis like a condom. It contains a tube that transports urine into a collection bag you wear on your thigh.
Artificial urinary sphincter (AUS)
An AUS is a surgically implanted device that lets you control your urine flow.
A surgeon will place a cuff at the top of your urethra. When the cuff is full, it closes off your urethra to prevent leakage. The cuff connects to a pump in your scrotum that allows you to control its release manually.
There isn’t a lot of scientific evidence to support the use of alternative treatments for stress incontinence. Still, you may wish to bring them up with a healthcare professional.
Some people use Botox to help treat OAB and urge incontinence. A clinical trial is underway to assess its benefit for females with stress incontinence.
Conservative treatments can often reduce the effects of stress incontinence. Surgery is effective in providing long-term relief for people with severe symptoms.
You don’t have to live with stress incontinence. Still, you may choose to wear pads that absorb leakage. Today’s pads are comfortable and impossible for others to see through your clothing.
Stress incontinence refers to urinary leakage during activities such as laughing and coughing. Conservative treatments such as Kegel exercises are often enough to reduce stress incontinence leaks.
If conservative treatments fail, a clinician has many options to consider depending on your situation and preferences. Talk with a healthcare professional to discuss which option may be best for you.