Stress Incontinence

Stress incontinence is the medical term for when something causes urine (pee) to leak by putting pressure on your urinary bladder and urethra. You may release small amounts of pee during certain activities, such as:

• Coughing
• Jumping
• Laughing
• Lifting heavy objects
• Running
• Sneezing

Stress incontinence is the most common type of urinary incontinence. It most often affects the urinary system in females. As many as 37 in 100 females will experience stress urinary incontinence at some point. It’s less common in males. But it does happen.

Another name for stress incontinence is stress urinary incontinence (SUI).

What are the symptoms of stress incontinence?

Leaking pee when there’s pressure on your bladder is the primary sign of stress incontinence. Mild stress incontinence may cause you to leak a few drops of pee while laughing, coughing, sneezing, squatting or doing heavy exercise.

If you have moderate or severe stress incontinence, you may leak more than a tablespoon of pee during less strenuous activities, like bending over or standing up. You may even leak pee during sexual intercourse.

What does it feel like?

For many people, you may not feel like you have to pee. But an activity or movement suddenly causes you to leak pee, which you may feel dribbling out.

What are the causes of stress incontinence?

Stress incontinence happens with sudden pressure on your bladder, allowing pee to come out.

For many people, the muscles that support your urethra (pelvic floor muscles) are strong enough to prevent leaks. But if those muscles weaken, they can’t support your urethra when they encounter pressure.

Risk factors

Anybody can have stress incontinence. But it affects twice as many women as men. About 1 out of every 2 females 65 and older has stress urinary incontinence. But this isn’t a normal part of aging. It’s a sign of a problem that can improve with the right treatment.

Risk factors for stress incontinence include:

• Being 65 or older
• A body mass index (BMI) greater than 25 (having overweight/obesity)
• Chronic (long-term) constipation
• Chronic cough
• Diabetes
• Menopause
• Pelvic floor muscle weakness
• Pregnancy and childbirth (especially vaginal delivery)
• Smoking
• Uterine prolapse

At what age does stress incontinence begin?

Stress incontinence can occur at any age. But you may be more likely to have stress incontinence if you’re 65 or older.

Complications of stress incontinence

Stress incontinence can be embarrassing and cause anxiety or depression. Absorbent underwear and urinary pads can catch leaks. But you may worry that others can notice you’re wearing them or be self-conscious about odors. This may prevent you from going out in public or being far from a restroom.

Long-term exposure to urine can also irritate your skin, leading to a skin rash and sores.

How doctors diagnose stress incontinence

Before your appointment, a healthcare provider may ask you to keep a bladder diary for a few days. In your bladder diary, you’ll keep track of:

• How much you drink
• When you pee
• When you leak, and what you were doing before you leaked

At your appointment, the provider will review your bladder diary, ask about your symptoms and perform a physical exam. They may also recommend a pelvic exam.

You may need additional tests to help the provider determine the cause.

Tests that are used

A healthcare provider may recommend the following tests to diagnose the cause of stress incontinence:

• Bladder ultrasound: A bladder ultrasound is a painless imaging test that allows the provider to determine the health of your bladder, kidneys and other organs.
• Cystoscopy: The provider inserts a thin, flexible tool with a camera at the end (cystoscope) into your urethra and up to your bladder. The cystoscope allows them to examine your urinary system.
• Urinalysis: The provider examines a sample of your urine to look for signs of an infection. A urinalysis can help them determine if you have a urinary tract infection (UTI) or blood in your pee (hematuria), which may be a sign of a different condition.
• Urodynamic testing: This is a group of tests that helps the provider understand how well your urinary system holds and releases pee. Urodynamic testing also includes a post-void residual urine test. This test measures how much pee is still in your bladder after you pee.

Can pelvic floor exercises (Kegels) treat stress incontinence?

Yes, pelvic floor exercises (Kegels) can improve stress incontinence. Kegels strengthen your pelvic floor muscles. It can be challenging to correctly strengthen your pelvic floor muscles. You may need to work with a physical therapist who specializes in pelvic floor disorders. They can use biofeedback to ensure you work the right muscles. It can take four to six weeks of regular Kegel exercises to see your symptoms improve.

Anyone can do Kegels, including men.

How do you treat stress incontinence naturally?

In addition to Kegels, you can also help improve stress incontinence by:

• Eating high-fiber foods and drinking lots of water to prevent constipation, which can make incontinence worse
• Maintaining a healthy weight for you
• Managing conditions like diabetes and high blood pressure (hypertension)
• Quitting smoking or using other tobacco products
• Using the bathroom at set times (timed voiding)

What are stress incontinence treatments for women?

Stress incontinence treatments for females include:

• Vaginal estrogen creams, gels, rings or patches that strengthen your vaginal muscles and tissues after menopause
• Insertable vaginal pessary devices to support your urethra
• Urethral injections to temporarily bulk up your urethral muscle and keep the sphincter closed
• Surgery to place a sling that supports your urethra

What are stress incontinence treatments for men?

Men are more likely to develop incontinence after prostate cancer surgery. Stress incontinence treatments may include:

• An artificial urinary sphincter to help do the job of your sphincter
• Condom catheters to catch leaks
• A sling procedure to support the upper part of your urethra close to the sphincter muscle (urethral bulb)

Is there a medication that can treat stress incontinence?

No, there isn’t an approved drug treatment for stress incontinence. But some providers may recommend duloxetine (Cymbalta^®, Drizalma^®, Irenka^®), which can help stimulate the nerve that controls your urethral sphincter. This is an “off-label” use of the medication that doesn’t have U.S. Food and Drug Administration (FDA) approval.

When should I see my healthcare provider?

You should see a healthcare provider as soon as you develop symptoms of stress incontinence. They can help you determine its cause and recommend the best treatment for you.

You may wish to ask the provider the following questions:

• What’s causing stress incontinence?
• Do you recommend any tests?
• 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?

What can I expect if I have stress incontinence?

It depends on what’s causing stress incontinence. At-home therapies like Kegels and bladder training can greatly reduce or stop leaks. Other treatments can also significantly reduce or stop leaks. Stress incontinence can also sometimes go away without treatment, like after childbirth. A healthcare provider can give you a better idea of what to expect.

Can anxiety cause urine leakage?

Yes, anxiety is a risk factor in developing another type of urinary incontinence — urge incontinence. According to one study, nearly 1 out of every 4 people with overactive bladder has moderate to severe anxiety. Nearly 1 out of every 2 has some anxiety symptoms.

Can stress incontinence get worse?

Mild stress incontinence can become moderate or severe. You’re at a greater risk of stress incontinence getting worse if you smoke or don’t maintain a healthy weight for you.