Stress Incontinence

What is stress incontinence?

Stress incontinence causes urine to leak when something puts pressure on your bladder (the organ in the urinary system that holds pee). You may release small amounts of urine when you cough, sneeze or laugh. Physical exertion like jumping, running or lifting a heavy object can also cause you to pee.

How common is stress incontinence?

Stress incontinence is the most common type of urinary incontinence. It most often affects the urinary system in people assigned female at birth (AFAB). As many as 1 in 3 people who were AFAB will experience stress urinary incontinence at some point. It’s less common for the condition to affect men, but it does happen.

What are the types of urinary incontinence?

More than half of people with stress incontinence also have urge incontinence. Having both stress and urge incontinence is known as mixed incontinence. An overactive bladder causes urge incontinence. This type of urinary incontinence causes you to leak urine when you feel an urgent need to pee.

Overflow incontinence is a different type of urinary incontinence. It causes you to leak urine because your bladder is too full or you can’t completely empty it.

What causes stress incontinence?

Stress incontinence happens with sudden pressure on the bladder and urethra (the tube that carries urine from the bladder out of the body). This pressure causes the sphincter muscle inside the urethra to briefly open, allowing urine to come out. Any activity — bending over, jumping, coughing or sneezing, for example — may squeeze the bladder.

What are the risk factors for stress incontinence?

Anyone can have urinary incontinence, but the problem affects twice as many people AFAB as people assigned male at birth (AMAB). It’s estimated half of women over age 65 have stress urinary incontinence. But urinary incontinence is not a normal part of aging. It’s a sign of a problem that can get better with appropriate treatment.

Risk factors for stress incontinence include:

• Pregnancy and childbirth (particularly vaginal birth).
• Menopause.
• Nerve injuries to the pelvis or lower back.
• Obesity.
• Pelvic surgery, such as a hysterectomy.
• Chronic coughing.
• Diabetes.
• Surgery for prostate cancer or an enlarged prostate (benign prostatic hyperplasia).
• Uterine prolapse.

What are stress incontinence symptoms?

Leaking urine when there’s pressure on your bladder is the top sign of stress incontinence. Mild stress incontinence may cause you to leak drops of urine during activities like heavy exercise, laughing, coughing or sneezing.

With moderate to severe stress incontinence, you may leak more than a tablespoon of urine even during less strenuous activities like standing up or bending over. You may even leak urine while having sex.

How is stress incontinence diagnosed?

Your healthcare provider will perform a physical exam (and a pelvic exam for people AFAB) and ask about symptoms. You may need to keep a bladder diary for two to three days to monitor your fluid intake, bathroom use and urine leakage. Your notes should include what you were doing before the leakage. This information can help your provider make a diagnosis.

Tests for stress incontinence include:

• Urinary pad test: You wear an absorbent pad(s) for 24 hours at home. Your provider weighs the pad after use to determine the volume of leaked urine.
• Urinalysis: This test checks for signs of infection in a urine sample. Urinalysis can help determine if you have a urinary tract infection (UTI) or blood in your urine (hematuria). These signs may indicate a different problem.
• Bladder scan: A brief ultrasound in your healthcare provider’s office to make sure you are emptying your bladder when you pee.
• Ultrasound: A pelvic or abdominal ultrasound assesses the health of the bladder, kidneys and other organs.
• Cystoscopy: During a cystoscopy, your provider uses a scope to examine your urinary tract.
• Urodynamic testing: This group of tests gauges how well your urinary system holds and releases urine. Urodynamic testing includes a postvoid residual urine test. The test measures how much urine is still in the bladder after you pee.

Can pelvic floor exercises (Kegels) treat stress incontinence?

Yes, pelvic floor exercises (Kegels) can improve stress incontinence. These exercises strengthen the muscles that support your urinary system. It can be challenging to correctly work and strengthen your pelvic floor muscles.

A physical therapist who specializes in pelvic floor disorders can help you master the proper techniques. This provider may use biofeedback to ensure you work the right muscles. It can take four to six weeks of regular exercise to see symptoms improve.

How do you treat stress incontinence naturally?

In addition to pelvic floor exercises, these steps can also improve stress incontinence:

• Eat high-fiber foods and drink plenty of water to prevent constipation, which can make incontinence worse.
• Get help to quit smoking or using tobacco products.
• Maintain a healthy weight.
• Manage conditions like diabetes and high blood pressure.
• Use the restroom at set times (bladder training or timed voiding).

What are stress incontinence treatments for women?

Stress incontinence treatments for women include:

• Vaginal estrogen creams, gels, rings or patches that strengthen vaginal muscles and tissues after menopause.
• Insertable vaginal pessary devices that support the bladder and urethra.
• Urethral injections to temporarily bulk up the urethral muscle and keep the sphincter closed.
• Surgery to place a sling made of your tissue, donor tissue or surgical mesh under the urethra to support it.

What are stress incontinence treatments for men?

Men are most likely to develop incontinence after prostate cancer surgery. Stress incontinence treatments for men include:

• Condom catheters (also called Texas catheters) cover the penis and have a catheter at the tip to drain urine into a bag. This would catch the leakage but not prevent it.
• Male sling procedure to place a surgical mesh sling that supports the urethral bulb (the upper part of the urethra close to the sphincter muscle).
• Surgery to place an artificial sphincter device that keeps the urethra closed until you press a pump to open the device to pee.

What are the complications of stress incontinence?

Severe stress incontinence can be embarrassing and may make you feel anxious or depressed. Adult diapers and absorbent urinary pads can catch urine leaks, but you may become self-conscious about an odor or worry that people can notice that you’re wearing them. You may not want to go out in public or be far from a restroom. Continuous urine on your skin can irritate it, leading to skin rashes and sores.

How can I reduce my risk of stress incontinence?

These steps may lower your chances of developing urinary incontinence:

• Don’t smoke.
• Lose weight, if needed, and maintain a healthy weight.
• Practice pelvic floor exercises daily, especially during pregnancy.
• Take steps to prevent constipation.

What is the outlook for someone with stress incontinence?

At-home therapies like pelvic floor exercises and working with a pelvic floor physical therapist can greatly improve stress incontinence. When needed, other treatments can help significantly reduce or stop urine leakage.

What should I ask my provider?

You may want to ask your healthcare provider:

• What type of urinary incontinence do I have?
• What is causing the stress incontinence?
• What did the test results show?
• Are there treatments I can try at home?
• What are the other treatment options?
• Is surgery right for me?
• What are the risks of surgery?

Can stress incontinence get worse?

Stress incontinence that is mild can progress to moderate or severe. This is most likely to happen if you gain a lot of weight (or don’t lose excess weight). Symptoms may worsen if you continue to smoke or don’t take other steps to manage the condition.

What is the difference between stress incontinence and urge incontinence?

These two types of urinary incontinence have different causes and symptoms:

• Abdominal pressure, urethral problems and pelvic floor weakness cause stress incontinence. Most people leak a small amount of urine.
• Bladder problems cause urge incontinence. People with urge incontinence may leak a lot of urine immediately after experiencing an urgent need to pee.

A note from Cleveland Clinic

Depending on the severity of the stress incontinence, leaking urine may be an inconvenience or embarrassing. You may become hesitant to be far from a bathroom. Or you may choose not to exercise for fear of leaking urine. Many people can improve their symptoms by regularly doing pelvic floor exercises. For moderate to severe stress incontinence, devices, injections or surgical procedures can help.