This factsheet is for people who have stress incontinence, or who would like information about it.
Urinary incontinence is the unintentional leaking of urine. Stress incontinence is when you suddenly leak urine because of an increase of pressure on your bladder. This could be from sneezing, coughing or lifting something heavy.
Stress incontinence is often referred to as bladder weakness or weak bladder. It’s the most common type of incontinence. It can affect women and men of any ages but it’s more common among women – approximately one third of women in the UK have stress incontinence.
Other types of urinary incontinence include the following.
Some people with severe stress incontinence have constant urine loss (also known as total incontinence). This usually occurs because the urethral sphincter (a group of muscles that surrounds your urethra and keeps urine in your bladder) doesn’t close properly.
If you have stress incontinence, small amounts of urine leak from your bladder when it’s under sudden, unexpected pressure. This can be from laughing, coughing, sneezing, walking, exercising, lifting a heavy object or from changing position, for example, sitting to standing. Carrying out any movement that suddenly increases the pressure on your bladder can cause uncontrollable loss of small amounts of urine.
Stress incontinence usually develops when the muscles in the pelvic floor or urethral sphincter have been damaged or weakened. Your pelvic floor is made up of layers of muscles that form a sling passing from your coccyx (tip of your spine) to your pubic bone. It supports the bladder, bowel and uterus (womb), and forms the floor of the pelvis. Both men and women have a pelvic floor.
There are a number of factors that make you more likely to develop stress incontinence. For women, these can include the following.
Men can develop stress incontinence as a result of prostate surgery. The urethral sphincter is close to the top of the prostate and may be slightly injured when the prostate is removed.
Other factors that increase the likelihood of developing stress incontinence in both men and women include:
To diagnose stress incontinence, your GP will first ask you about your symptoms and medical history. He or she may ask you to keep a ‘bladder diary’ for at least three days. This involves recording how much you drink, when you pass urine, the amount of urine you produce, whether you had an urge to urinate and the number of times you unintentionally leak.
Your GP will usually do a test on a sample of your urine to check that your incontinence isn’t being caused by an infection in your urinary tract – this consists of your kidneys, two ureters (the tubes that connect each kidney to your bladder), your bladder and your urethra. He or she may also do a blood test to check that your kidneys are working properly.
Your GP may examine you. He or she might simply check for loss of urine while you cough or strain. A rectal (back passage) examination will check if you’re constipated or whether the nerves to your bladder are damaged. In men, a rectal examination will determine if the prostate is enlarged. If you’re a woman, your GP will check for weakness of your pelvic floor and look for a prolapse – this is when organs near your vagina, such as your womb, bowel or bladder, slip down from their normal position.
You may be referred to a urologist (a doctor who specialises in identifying and treating conditions that affect the urinary system) or, if you're a woman, a gynaecologist (a doctor who specialises in women’s reproductive health) or urogynaecologist (a doctor who focuses on urinary and associated pelvic problems in women).
Other tests for stress incontinence include the following.
There are several ways you can help yourself if you have been diagnosed with stress incontinence.
Being overweight or obese can make your stress incontinence worse because there is extra pressure on your pelvic floor muscles. Exercising and eating healthily can help you to lose excess weight. Try to do 150 minutes (two and a half hours) of moderate exercise over a week. You can do this by carrying out 30 minutes on at least five days each week. Do low-impact exercises, such as walking or swimming. High-impact exercise, such as running or sports involving jumping, can increase the pressure on your bladder and cause you to leak.
Drink enough fluid. Cutting down the amount you drink makes your urine more concentrated and it’s likely to make your stress incontinence worse. Try to drink six to eight glasses of fluid regularly throughout the day. Passing urine frequently to prevent having a full bladder can also help.
Other things you can do to help yourself include the following.
Your GP will usually ask you to do pelvic floor muscle exercises (Kegel exercises). These exercises, if done correctly, strengthen your urethral sphincter and pelvic floor muscles to help you control urinating. To do pelvic floor muscle exercises, squeeze the muscles you would use to stop urinating and hold for a count of three. Your GP will recommend that you do these exercises frequently for several months. For more information, see FAQs.
Ask your GP for help if you're not sure whether you're exercising the right muscles. He or she may suggest trying biofeedback techniques. Biofeedback therapy uses a computer and electronic instruments to tell you when you're using the right pelvic floor muscles.
If you’re a woman, your GP might recommend vaginal cones. These are weights that you hold in your vagina that help you strengthen the pelvic floor.
Your GP may prescribe you a medicine called duloxetine. This medicine increases the activity of the nerve that stimulates the urethral sphincter to improve how well it works and prevent leaks. Duloxetine isn’t suitable for everyone, as there are side-effects, so always ask your GP for advice and read the patient information leaflet that comes with your medicine.
If you’re a woman and your stress incontinence is being caused by a lack of oestrogen, your GP might prescribe you an oestrogen cream or oestrogen tablets to insert into your vagina.
Some people might find that neuromuscular stimulation of the pelvic floor is helpful. This is suitable for both men and women. A probe is placed into the vagina (for women) or rectum (for men). The probe has an electrical current that can help to exercise and strengthen the pelvic floor muscles.
Injections of bulk-forming agents, such as collagen, around your urethra can be effective. This helps keep your urethra closed and reduces urine leakage. The procedure is usually done by a urological specialist and takes around five minutes, although you will probably need to have repeat injections. You will have a local anaesthetic for this treatment – this completely blocks pain from the area and you will stay awake during the procedure.
If you have severe stress incontinence and other treatments haven’t been effective, your GP might recommend that you have surgery to strengthen or tighten the tissues around your urethra. As with every procedure, there are some risks associated with having surgery for bladder problems. Talk to your GP or surgeon about your surgical options and the risks that are associated with each one.
Surgical options include the following.
For answers to frequently asked questions on this topic, see FAQs.
For sources and links to further information, see Resources.
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This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.
Produced by Alice Rossiter, Bupa Health Information Team, January 2012.
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