Stress Incontinence

by Ken Walker


Stress incontinence means you leak urine when you increase the pressure on the bladder when coughing, sneezing or exercising. It happens when the pelvic floor muscles that support the bladder are weakened. Stress incontinence is the most common form of urinary incontinence and is more prevalent in women than men.

About Urinary Stress Incontinence

Stress incontinence is caused by external pressure or stress on the bladder. The extra pressure causes urine to leak from the bladder. The amount of urine that will leak depends on the severity of the incontinence as well as how much pressure is applied to the bladder. The pressure on the bladder can be caused by physical exercise such as lifting a heavy object  coughing sneezing or laughing. The leaking of urine is usually because of weakness in the pelvic muscles that support the bladder.

Stress incontinence is the most common form of urinary incontinence, affecting about 4% of the population. It is generally affects older women rather than younger ones. As many as 1 in 5 women over 40 have some degree of stress incontinence. Stress incontinence is less common amongst men.

What causes stress incontinence?

According to the Mayo Clinic, “Stress incontinence occurs when the muscles and other tissues that support the bladder (pelvic floor muscles) and the muscles that regulate the release of urine (urinary sphincter) weaken.

The bladder expands as it fills with urine. Normally, valve-like muscles in the urethra — the short tube that carries urine out of your body — stay closed as the bladder expands, preventing urine leakage until you reach a bathroom. But when those muscles weaken, anything that exerts force on the abdominal and pelvic muscles — sneezing, bending over, lifting, laughing hard, for instance — can put pressure on your bladder and cause urine leakage.

Your pelvic floor muscles and urinary sphincter may lose strength because of:

Childbirth. In women, poor function of pelvic floor muscles or the sphincter may occur because of tissue or nerve damage during delivery of a child. Stress incontinence from this damage may begin soon after delivery or occur years later.

Prostate surgery. In men, the most common factor leading to stress incontinence is the surgical removal of the prostate gland (prostatectomy) to treat prostate cancer. Because the sphincter lies directly below the prostate gland and encircles the urethra, a prostatectomy may result in a weakened sphincter.

Contributing factors

Other factors that may worsen stress incontinence include:

  • Illnesses that cause chronic coughing or sneezing
  • Obesity
  • Smoking, which can cause frequent coughing
  • Excess consumption of caffeine or alcohol
  • High-impact activities over many years
  • Hormonal deficiency”

Getting diagnosed

Stress incontinence can be diagnosed in a variety of different ways. Generally, you would visit an urologist who would do specialised tests to ascertain if stress incontinence is evident. A bladder stress test, whereby your doctor will ask you to cough forcefully to see if any urine leaks out, could also be done. Your urine could also be analysed to see if any irregularities are found. For difficult cases of stress incontinence, an ultrasound may be done to create a holistic image of your bladder, urethra, pelvic floor muscles etc. Your doctor may also ask you to keep a ‘bladder diary’ to record how often you use the toilet and how much urine there is every time you go. This diary and your medical history may help your doctor diagnose your problem, or at the very least help your doctor send you for the right diagnostic tests.

Stress incontinence treatment

If you suffer from stress incontinence, you may feel self-conscious, keep to yourself or curtail the professional and social aspects of your life, in particular exercise and other activities. But with treatment for your stress incontinence, you would be able to lead a relatively trouble-free life. Your treatment will depend on the severity of your stress incontinence and its root cause.

Here are the most commonly used stress incontinence management techniques, exercises and tips:

Pelvic floor exercises / kegel exercises: These exercises strengthen and improve the performance of your pelvic floor muscles and decrease the chance that stress incontinence will strike.

Behavioural changes: The wide variety of behavioural modifications that can be used to combat stress incontinence include:

  • Drinking fewer liquids and in particular coffee and alcohol
  • Going to the bathroom more often so that your bladder is seldom full
  • Avoiding activities that might lead to stress incontinence. For example, jumping or strenuous running
  • Giving up smoking to avoid getting a chronic cough
  • Losing weight if you are overweight
  • Avoiding drinks and food that might aggravate your bladder like curries and fizzy soft drinks

Incontinence medication: Medication can sometimes be used to treat stress incontinence. It is usually more effective with people who don’t suffer from severe cases of the ailment. These medications usually work by helping your bladder leak less urine

Incontinence surgery: This is normally the last resort and should only be performed if all other treatment options have been exhausted.

Suffering from stress incontinence is not a normal part of aging or childbirth and definitely not something that you need to learn to live with. Solutions are available to help manage stress incontinence by decreasing its impact on your everyday activities. You may need to speak to your doctor or get a referral to a specialist so the two of you can map out a plan to manage your stress incontinence.

For products to help manage urinary incontinence click here.

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