Stress incontinence is the leakage of urine out of the bladder when you jump, cough, sneeze, laugh, lift a heavy object, have sex, or do anything else that puts pressure on the bladder. Often only a small amount of urine leaks out, although in more severe cases, the pressure of a full bladder overcomes the body's ability to hold in urine.
Stress incontinence occurs when the urethral sphincter, the pelvic floor muscles, or both of these structures have been weakened or damaged and can't dependably hold in urine. This can happen due to:
- injury to the urethral area
- surgery in the pelvic area, including prostate surgery in men
- some medications
Stress incontinence is the most common type of incontinence in women.
Diagnosing stress incontinence
To identify any problems that might be causing incontinence, your doctor will ask you to describe your symptoms in as much detail as possible. You might be asked to keep a diary of urinations and fluid intake for a few days. Your doctor will also want to know about all surgeries, pregnancies, and medications you are taking, since certain drugs can cause incontinence by increasing urine production or relaxing muscles of the bladder or urethra (see Medications that can cause urinary incontinence). A physical exam will include a genital exam for men, a pelvic exam for women, and a rectal exam for either sex. Other tests may include:
- urinalysis to check for a urinary tract infection
- urinary stress test (standing upright with a full bladder and then coughing)
- a post-void residual test to measure the amount of urine left in the bladder after you urinate
- cystoscopy to look inside the bladder
- pelvic or abdominal ultrasound
- tests to measure pressure and urine flow
- an x-ray to look at the bladder and kidneys
Treating stress incontinence
Treatment choices for urinary incontinence range from lifestyle changes to surgery. The right treatment for you depends on what is causing your stress incontinence and your preferences for treatment. Keep in mind that no treatment works perfectly, and you may have to try more than one approach before you find the one that best suits your needs. Women and men may need different treatments for the same thing.
Treatments for stress incontinence include:
- fluid management. This means drinking less fluid during the day, which lets the bladder handle less fluid.
- pelvic floor physical therapy. Basic pelvic muscle exercises are called Kegel exercises. They involve identifying the pelvic muscles (pretend you are trying to avoid passing gas), contracting them for a few seconds, relaxing, repeating 10 or more times, and doing this several times a day (see How to perform Kegel exercises). Some women find that using vaginal weighted cones helps boost the power of their pelvic floor exercises.
- biofeedback. A biofeedback device can help you identify pelvic floor muscles and learn to strengthen and control them.
- electrical stimulation. Using an electrical stimulator at home can help men and women who aren't able to effectively exercise their pelvic floor muscles. The device delivers a small electric current that makes the pelvic muscles contract painlessly.
- medications. Alpha-adrenergic agonists such as phenylephrine and pseudoephedrine and antidepressants such as amitriptyline and imipramine ease stress incontinence in some people.
- surgical procedures. When lifestyle changes and other less-invasive treatments don't work, procedures such as the urethral sling, bladder neck suspension, or implantation of an artificial sphincter can stop stress incontinence.
- injection of bulking agents. The injection of tiny beads or particles suspended in gel around the urethra can help men who have had their prostates removed and women with the type of stress incontinence known as intrinsic sphincter deficiency, in which the urinary sphincter no longer closes completely and allows urine to leak out, particularly with exertion.