Stress incontinence is losing urine without meaning to during physical activity, such as coughing, sneezing, laughing, or exercise.
Incontinence - stress
To hold urine and control urination, the lower urinary tract and nervous system need to be working normally. You must also be able to recognize and respond to the urge to urinate.
The average adult bladder can hold over 2 cups (350 ml - 550 ml) of urine. Two muscles are involved in controlling urine flow:
In stress incontinence, the sphincter pelvic muscles, which support the bladder and urethra, are weakened. The sphincter is not able to prevent urine from flowing when pressure is placed on the abdomen (such as when you cough, laugh, or lift something heavy).
Stress incontinence may occur from weakened pelvic muscles that support the bladder and urethra or because the urethral sphincter is not working correctly. Weakness may be caused by:
Stress urinary incontinence is the most common type of urinary incontinence in women.
Stress incontinence is often seen in women who have had more than one pregnancy and vaginal delivery. It is also common in women whose bladder, urethra, or rectum wall stick out into the vagina (pelvic prolapse).
Risk factors for stress incontinence include:
The main symptom of stress incontinence is losing urine without your control. It may occur when you:
The health care provider will perform a physical exam, including a:
In some women, a pelvic examination may show that the bladder or urethra is bulging into the vagina.
Tests may include:
Treatment depends on how severe your symptoms are and how much they affect your everyday life.
Your health care provider may ask you to stop smoking (if you smoke) and avoid caffeinated beverages (such as soda) and alcohol. You may be asked to keep a urinary diary, recording how many times you urinate during the day and night, and how often you leak urine.
There are four types of treatment for stress incontinence:
Examples of behavior changes include:
PELVIC FLOOR MUSCLE TRAINING
Pelvic muscle training exercises (called Kegel exercises) may help control urine leakage. These exercises keep the urethral sphincter strong and working properly.
Some women may use a device called a vaginal cone with pelvic exercises. You place the cone into the vagina. Then you try to squeeze the pelvic floor muscles to hold the cone in place. You can wear the cone for up to 15 minutes at a time, twice a day. Within 4 to 6 weeks, most women have some improvement in their symptoms.
Biofeedback and electrical stimulation may be helpful for people who have trouble doing pelvic muscle training exercises. These two methods can help you find the correct muscle group to work. Biofeedback can also help you learn how to control certain body responses.
Electrical stimulation therapy uses a low-voltage electrical current to stimulate and contract the correct group of muscles. The current is delivered using an anal or vaginal probe. The electrical stimulation therapy may be done at the health care provider's office or at home.
Treatment sessions usually last 20 minutes and may be done every 1 to 4 days. Newer techniques are being studied. One new technique uses an electromagnetic chair to make the pelvic floor muscles contract when the person is sitting.
Medicines tend to work better in patients with mild to moderate stress incontinence. There are several types of medications that may be used alone or in combination. They include:
Estrogen therapy can be used to improve urinary frequency, urgency, and burning in women who have gone through menopause. It also can improve the tone and blood supply of the urethral sphincter muscles.
However, it is not clear whether estrogen treatment improves stress incontinence. Some hormone treatments given after menopause have been shown more harmful than helpful to women's health. Women who have a history of breast or uterine cancer usually should NOT use estrogen therapy to treat stress urinary incontinence.
Surgery is only recommended after the exact cause of urinary incontinence has been found. Most of the time, your health care provider will try bladder retraining or Kegel exercises before considering surgery.
Most health care providers recommend that their patients try other treatments before having surgery.
Depending on the success of treatment and other medical problems you have, you may need a urinary catheter to drain urine from the bladder.
Behavior changes, pelvic floor exercise therapy, and medication usually improve symptoms. However, they will not cure stress incontinence. Surgery can cure patients, if they are good candidates.
Treatment does not work as well in people with:
Complications are rare and usually mild, but they can include:
The condition may get in the way of social activities, careers, and relationships.
Call for an appointment with your health care provider if you have symptoms of stress incontinence and they bother you.
Performing Kegel exercises (tightening the muscles of the pelvic floor as if trying to stop the urine stream) may help prevent symptoms. Doing Kegel exercises during and after pregnancy can decrease the risk of developing stress urinary incontinence after childbirth.
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Resnnick NM. Incontinence. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 25.
Deng DY. Urinary incontinence in women. Med Clin North Am. 2011;95:101-109.