Stress incontinence
Stress incontinence is the inability to control the release of urine when pressure on the belly muscles increases. This can occur when a person laughs, coughs, sneezes, lifts a heavy object, or jogs.
Increased pressure on the top of the bladder created by one of these actions forces urine past the muscle (sphincter) that normally keeps urine in the bladder. This results in the leaking of urine.
Stress incontinence is a common form of urinary incontinence. Many things may cause changes in the pelvic muscles and supporting structures that lead to stress incontinence. These include childbirth (especially vaginal delivery), low levels of estrogen, nerve or muscle damage from surgery, and being overweight. Some medicines can also cause stress incontinence.
Stress incontinence often responds well to pelvic floor exercises (Kegels). These exercises can help strengthen the muscles that control the flow of urine. They involve squeezing the muscles you would use if you were trying not to pass gas or if you were stopping the flow of urine.
Other treatment options may include medicines, surgery, or incontinence pessaries. (An incontinence pessary is a soft, flexible device that is placed in the vagina to compress the urethra and help prevent urine leaks.)
What are the symptoms of stress incontinence?
The main symptom of stress incontinence is the leaking of urine when you sneeze, cough, laugh, lift something, change position, or do something that puts stress or strain on your bladder. With this type of bladder control problem, you may leak a small to moderate amount of urine.
How is stress incontinence treated?
Stress incontinence can be treated in many ways. Pelvic floor muscle exercises (Kegels) can help strengthen the muscles that control the flow of urine. Medical devices like a pessary or a penile clamp may be used. Surgery may be done to support, lift, or compress the urethra (perineal or urethral sling).
How is stress incontinence diagnosed?
Your doctor will ask you about your health history. You'll be asked how often and how much you urinate and leak urine. Your doctor will also do a physical exam and check a sample of your urine. Other tests may be needed to make sure your incontinence isn't caused by another condition.
How can you care for yourself when you have stress incontinence?
- Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
- Limit caffeine, carbonated drinks, and alcohol. They make you urinate more.
- Try pelvic floor (Kegel) exercises, which tighten and strengthen pelvic muscles. (If doing these exercises causes pain, stop doing them and talk with your doctor.) To do Kegel exercises:
- Squeeze your muscles as if you were trying not to pass gas. Or squeeze your muscles as if you were stopping the flow of urine. Your belly, legs, and buttocks shouldn't move.
- Hold the squeeze for 3 seconds, then relax for 5 to 10 seconds.
- Start with 3 seconds, then add 1 second each week until you are able to squeeze for 10 seconds.
- Repeat the exercise 10 times a session. Do 3 to 8 sessions a day.
- Prevent constipation. Make sure you drink enough fluids and include fruits, vegetables, and fiber in your diet each day.
- If you're overweight, talk to your doctor about safe ways to lose weight. Losing weight can help with stress incontinence.
- Wearing pads that absorb the leaks may help for a time. Pads designed to absorb urine work best.
- Keep skin in the genital area dry. Petroleum jelly (like Vaseline) spread on the area may help protect your skin.
How is surgery used to treat stress incontinence?
Surgery may be used if other treatments, such as pelvic floor exercises (Kegels) and medications, aren't helping enough. There are different kinds of surgeries to help with stress incontinence. They include:
- Urethral bulking. Material is injected around the urethra, the tube that carries urine from your bladder to the outside of your body. This is done to build up the thickness of the wall of the urethra so it seals tightly when you hold back urine.
- Perineal or urethral sling. A sling is placed beneath the urethra. The sling may be used to lift, support, or compress the urethra.
- Artificial urinary sphincter. A silicone cuff is fitted around the urethra. The device also includes a balloon reservoir and a pump. You can inflate or deflate the device to control urination.
Stress incontinence: Fast Facts
What causes stress incontinence?
Stress incontinence is caused by conditions that stretch, weaken, or damage the pelvic floor muscles. When these muscles can't support the urethra and bladder, you can leak urine. Stress incontinence can be caused by childbirth or weight gain. And it can happen when the prostate is removed or after radiation treatment for prostate cancer.
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