Stress incontinence

Published by Bupa's Health Information Team, March 2010.

This factsheet is for people who have stress incontinence, or who would like information about it.

Urinary incontinence is passing urine unintentionally. Stress incontinence is when urine leaks because of extra, often unexpected, pressure on the bladder.

About stress incontinence

Stress incontinence is the most common type of incontinence. It affects around two million people in the UK. It's much more common in women than men, especially among women who have had babies or been through the menopause.

Other types of urinary incontinence include the following.

• Urge incontinence - when you frequently have an urgent need to pass urine and leak unintentionally. For more information, see Related topics.
• Mixed incontinence - when you have stress and urge incontinence together.
• Overflow incontinence - this happens when your bladder fills up to the point where it can't expand any more, and causes constant dribbling day and night. It can be caused by a blockage in the urethra (the tube that carries urine from your bladder out of your body) or bladder or damage to the nerves that supply the bladder.

Symptoms of stress incontinence

Small amounts of urine leak from your bladder when it's under sudden unexpected pressure, for example when you cough, laugh, sneeze, exercise or lift something heavy.

Causes of stress incontinence

Stress incontinence usually develops when your pelvic floor muscles or your urethral sphincter have been damaged, weakening them. Your pelvic floor muscles form a sling passing from your coccyx (tip of your spine) at the back to your pubic bone at the front, supporting your bladder, uterus and bowel. Your urethral sphincter is the band of muscles that goes around your urethra and acts like a valve to stop urine leaking out.

Although there is no single cause of stress incontinence, there are a number of factors that make you more likely to develop the condition. For women, these include:

• pregnancy or childbirth, especially if you had a big baby, a forceps or ventouse delivery
• the menopause - you will have less oestrogen in your body, which can weaken your muscles
• a hysterectomy - this operation can damage your muscles

In men, stress incontinence can be a side-effect of a prostatectomy - an operation to remove your prostate gland.

Factors that increase the likelihood of stress incontinence in both men and women are:

• age - your muscles weaken as you get older
• being overweight - extra weight can put extra pressure on your bladder muscles
• having constipation for a long time
• certain medicines

Diagnosis of stress incontinence

Many people feel embarrassed about having stress incontinence, despite it being so common. Instead of trying to cope by yourself, contact your GP.

Your GP will ask about your symptoms. He or she will do a 'dipstick' test on a sample of your urine, to check that an infection such as cystitis isn't causing your incontinence and also to check for other problems such as gall stones. Your GP may also check for leakage when you cough.

You will usually be asked to keep a 'bladder diary' for three days. This involves you writing down all the fluids you drink, how much urine you pass and when you leak.

If you're a woman, other tests may include a physical examination - your GP will check the strength of your vaginal muscles and look for a prolapse (organs near your vagina, such as your womb, bowel or bladder, slipping down from their normal position), by inserting a finger into your vagina. Your GP may also test the sensation (your ability to feel) around the skin between your vagina and back passage.

Your GP may refer you to a urologist (a doctor who specialises in urinary problems), or if you're a woman, a gynaecologist (a doctor who specialises in problems with women's reproductive organs) or urogynaecologist (a doctor who specialises in urinary problems in women).

Your doctor may carry out urodynamic tests, which will show exactly what is going on when you urinate. Please see Related topics for more information.

Treatment of stress incontinence

Self-help

There's good evidence to suggest that if your body mass index (BMI) is over 30, losing excess weight can help relieve stress incontinence.

There's also evidence to suggest that if you're frequently constipated, treating this condition may help to relieve stress incontinence. To help prevent constipation, eat a healthy, balanced diet with plenty of fruit and vegetables. Make sure you drink enough fluids - don't cut back.

Wearing absorbent pads, which are widely available over-the-counter from your pharmacist, can help to make leaks less embarrassing.

Physical therapies

Your doctor will usually ask you to do Pelvic floor muscle exercises (Kegel exercises).

Pelvic floor muscle exercises involve contracting the muscles that start and stop your urine flow. You need to do at least 10 contractions, three times a day for three months. You will then have a review with your GP. You will need to keep doing your pelvic floor muscle exercises if they working.

If you're having trouble doing pelvic floor muscle exercises, your GP may recommend biofeedback or electrical stimulation. Biofeedback uses sensors to tell you when you're using the right pelvic floor muscles. Electrical stimulation involves applying a small electric current to help your pelvic floor muscles contract. These treatments aren't suitable for everyone, ask your GP for advice.

If you're a woman, your GP may advise you to use small plastic cone-shaped weights that you hold in your vagina when doing pelvic exercises. They force you to contract your pelvic floor muscles in order to hold the cone in place. As your muscle strength improves, you can use heavier cones.

Medicines

Your doctor may prescribe a medicine that works by stimulating a nerve that improves the function of your urethral sphincter to prevent leaks.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Non-surgical treatments

Bladder neck injections, of substances such as collagen, can increase your resistance to bladder emptying and prevent leaks. The injections are given along the wall of your urethra. The effects of the injections wear off over time and you may need to have repeat injections.

Surgery

If other treatments haven't been effective, your doctor may recommend you have surgery to strengthen your bladder control. There are several different options, which may be more appropriate for some people than others. Your surgeon will be able to discuss the best option with you. The options include the following.

• Tension-free vaginal tape (TVT) - for women only. Your surgeon places a synthetic mesh (tape) around your urethra as a support. The tape stops any leaks when your bladder comes under pressure. The procedure can be carried out as a day case under local anaesthetic, but it isn't suitable for all women, especially if you're planning to have children. Also, it's a new procedure, so surgeons aren't aware of the long-term effects. Another similar type of operation is called trans obturator tape (TOT).
• Burch colposuspension - for women only. This involves making a large cut in your abdomen (tummy) and lifting your bladder neck upwards to improve strength. The lower part of the front of your vagina is then sewn to a ligament behind your pubic bone. For more information see Related topics.
• Insertion of an artificial urinary sphincter - for men and women. This operation carries serious side-effects and is only carried out if other treatments have failed.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.