Stress Incontinence

Condition Basics

What is stress incontinence?

Stress incontinence means that you leak a small amount of urine when you do something that puts stress, strain, or pressure on your bladder. It can happen when you cough, laugh, strain, lift something, or change position.

What causes it?

Stress incontinence is caused by conditions that stretch, weaken, or damage the pelvic floor muscles. When these muscles can't support the urethra and bladder, you can leak urine. Stress incontinence can be caused by childbirth or weight gain. And it can happen when the prostate is removed or after radiation treatment for prostate cancer.

What are the symptoms?

The main symptom of stress incontinence is the leaking of urine when you sneeze, cough, laugh, lift something, change position, or do something that puts stress or strain on your bladder. With this type of bladder control problem, you may leak a small to moderate amount of urine.

How is it diagnosed?

Your doctor will ask you about your health history. You'll be asked how often and how much you urinate and leak urine. Your doctor will also do a physical exam and check a sample of your urine. Other tests may be needed to make sure your incontinence isn't caused by another condition.

How is stress incontinence treated?

Stress incontinence can be treated with:

• Pelvic floor muscle exercises (Kegels). These help strengthen the muscles that control the flow of urine.
• Diet and lifestyle changes. For example, limit caffeine, carbonated drinks, and alcohol. They make you urinate more.
• Medicines. An antidepressant medicine may help with bladder control. Estrogen cream may be used in the vagina. This may help with bladder control.
• Medical devices. These include:
  • Urinary catheter. This includes condom catheters.
  • Penile clamp. This may work for short-term use.
  • Incontinence pessary. This fits into the vagina and compresses the urethra.
• Injections of material around the urethra (urethral bulking). This can help prevent leaking.
• Surgery. This is done to put in a perineal or urethral sling to support, lift, or compress the urethra. This makes you less likely to leak urine when you sneeze, cough, or laugh. Surgery can be very effective, but it has risks. When deciding whether to have surgery, talk about the risks and benefits with your doctor.

There are products, like pads and disposable underwear, that absorb urine.

How is surgery used to treat it?

Surgery may be used if other treatments, such as pelvic floor exercises (Kegels) and medications, aren't helping enough. There are different kinds of surgeries to help with stress incontinence. They include:

• Urethral bulking. Material is injected around the urethra, the tube that carries urine from your bladder to the outside of your body. This is done to build up the thickness of the wall of the urethra so it seals tightly when you hold back urine.
• Perineal or urethral sling. A sling is placed beneath the urethra. The sling may be used to lift, support, or compress the urethra.
• Artificial urinary sphincter. A silicone cuff is fitted around the urethra. The device also includes a balloon reservoir and a pump. You can inflate or deflate the device to control urination.