What is Stress incontinence?

Stress incontinence

What is stress incontinence?

If you leak urine when you cough, sneeze, exercise or laugh, you most likely have a condition called stress incontinence. Many women get this problem, especially if they've had children.

You may think you just have to put up with this problem. You may even feel too embarrassed to go to your doctor. But there are many treatments for stress incontinence that work well.

If you have stress incontinence, the muscles that keep your bladder closed are weak. Things like sneezing and coughing put extra pressure on the muscles and urine leaks out. You can strengthen these muscles by doing special exercises called Kegel exercises (also called pelvic floor exercises).

To test your knowledge of stress incontinence, see How much do you know about stress incontinence?

Key points about stress incontinence

Stress incontinence is common. At least 1 in 6 women get it at some time in their life.
You're most likely to get stress incontinence after you've had a baby, and it can get worse as you get older.
If you're bothered by your stress incontinence, you should see your doctor. Treatment can help no matter how long you've had leaking.
Kegel exercises are the main treatment. They're safe and they work for most women.
Doctors can prescribe a drug treatment for stress incontinence. It's called duloxetine (brand name Cymbalta).
If your incontinence is bad, you may need surgery.
You may be able to keep from getting stress incontinence by following a few simple tips.

How things normally work

To understand stress incontinence, it helps to know about the parts of your body that make, carry and store urine.

Stress incontinence can stop you from enjoying exercise.

Your kidneys make urine. They're in the middle of your back, on either side of your spine. They take waste and extra fluid out of your blood. This becomes urine.
From your kidneys, urine flows down two tubes (one on each side of your body) called ureters and into your bladder.
Your bladder stores urine. It's a muscular bag, a bit like a balloon. It relaxes and tightens when it gets signals from your nervous system. When your bladder squeezes or tightens (contracts), urine is forced out.
From your bladder, urine flows out through a tube called the urethra and out of your body.
A ring of muscle called the urethral sphincter sits at the bottom of your bladder. This works like a valve. When it opens, urine flows out of your bladder. When it closes, it helps to hold urine in your bladder.
Underneath your bladder are your pelvic floor muscles. They're important because they help your bladder hold in urine.

How your body controls urine

When you're not passing urine, your urethral sphincter and your pelvic floor muscles stay tightly closed. This keeps the opening of your bladder closed, so urine can't get out.

Urine is made in your kidneys and stored in your bladder. Your pelvic floor muscles help your bladder hold in urine.

When your bladder gets full and you want to empty it, your brain sends a signal for your bladder to squeeze the urine out. At the same time, your sphincter muscles and your pelvic floor muscles relax. This lets urine flow out.

To find out more, see How much urine do you make, and how often should you go?

There's a lot you can do to keep these parts of your body healthy and reduce your chances of getting stress incontinence.

What goes wrong in stress incontinence?

Incontinence means that you have problems holding in urine. There are many types of incontinence. But stress incontinence is the most common type, especially for women. For more information, see Other types of incontinence.

If you have stress incontinence, it means that urine leaks from your bladder when something puts extra pressure on the muscles in this area. This often happens when you cough, sneeze, laugh, exercise or lift things. Usually only a little urine leaks, but it happens very quickly.

Source:
Agency for Health Research and Quality.
Urinary incontinence in adults: acute and chronic management.
Clinical Practice Guideline No. 2 (1996 Update), AHPCR Publication No. 96-0682: March 1996

Two things can lead to stress incontinence:

Source:
Ashton-Miller JA, Howard D, Delaney JOL.
The functional anatomy of the female pelvic floor and stress continence control system.
Scandinavian Journal of Urology and Nephrology. 2001; 207 (supplement): 1-7.

Your pelvic floor muscles get weak and can't tighten (contract) properly. This is the most common cause of stress incontinence.
Your sphincter muscles get weak and can't contract properly.

All these muscles help keep the opening from your bladder (the bladder neck) closed. If they're weak, they can't cope with any extra pressure on them, say from a sneeze. So if you do sneeze, your bladder neck opens for a second. This lets a bit of urine leak out.

Why me?

Some women are more likely to get stress incontinence than others.

You're more likely to get stress incontinence after you've had a baby.

Most women who get stress incontinence get it after they've had a baby. Other things that can cause stress incontinence include smoking (now or in the past), being very overweight (obese), some kinds of surgery, constipation and coughing a lot.

To find out more, see Who's at risk for stress incontinence?

Sources for the information on this page:

Agency for Health Research and Quality.Urinary incontinence in adults: acute and chronic management.Clinical Practice Guideline No. 2 (1996 Update), AHPCR Publication No. 96-0682: March 1996

Ashton-Miller JA, Howard D, Delaney JOL.The functional anatomy of the female pelvic floor and stress continence control system.Scandinavian Journal of Urology and Nephrology. 2001; 207 (supplement): 1-7.

This information was last updated on Nov 18, 2008

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment.
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