Stress Urinary Incontinence

As defined by the National Institute for Health and Care Excellence, stress incontinence is "involuntary urine leakage on effort or exertion or on sneezing or coughing". It is sometimes referred to as exercise induced urine leakage, as it often happens when you exercise. There are certain high impact exercises, such as running, that are more likely to cause you to leak.

Stress incontinence is the most openly talked about form of incontinence, it is extremely common, effecting 200 million men and women worldwide. As many as 45% of women are reported to suffer from stress incontinence, with the true figure predicted to be much higher. Women are more likely to develop it after pregnancy and childbirth, and studies suggest your vulnerability increases considerably when you are over 30 years old, however, even young girls and men of all ages can develop stress incontinence.

There are many treatments available for stress incontinence, so it is important that you do not allow it to go untreated for longer than needed. Even though it is not life threatening, it can greatly reduce your quality of life as it develops into fully emptying your bladder each time it is put under pressure.


Symptoms of Stress Urinary Incontinence

You may be suffering from stress incontinence if you leak a small or large amount when you:

  • giggle or laugh
  • sneeze
  • cough
  • exercise
  • crouch down / squat

If you leak only when you laugh, you may instead be suffering from giggle incontinence.


Causes of Stress Urinary Incontinence

Stress incontinence occurs when you have a weak or damaged pelvic floor, and/or weak or damaged sphincter muscles. These are then unable to support the bladder in holding urine when put under stress; such as when you cough or sneeze and the intra-abdominal pressure increases.

There are many things which cause damage to these structures, the specific events which often lead to stress incontinence are listed below:

  • Pregnancy - Throughout pregnancy your body undergoes a number of changes. The weight of your baby puts pressure on your pelvic floor muscles, weakening them. Your pelvic floor muscles are encouraged to loosen further by the pregnancy hormones that are produced, meaning your pelvic floor can end up being much slacker than it was before you fell pregnant. As a result, even if you undergo a caesarean to deliver your baby, you can suffer from stress incontinence.
  • Childbirth - Even through an uncomplicated vaginal delivery, you can sustain nerve damage in your vagina and pelvic area from the movement of the baby. If you have a vaginal tear or episiotomy you are more likely to suffer.
  • Ageing and the menopause - Inevitably you undergo a change in hormones as you age. These leave the muscles, ligaments and fibres supporting your pelvic organs less ‘elastic’ than they once were.
  • Being overweight - Having a BMI of more than 30 means you have unnecessary weight sitting on your pelvic floor, causing it to weaken.
  • Medication - Some medication can contribute to stress incontinence, such as statins, by relaxing your muscles meaning your pelvic floor cannot support your bladder and urethra as effectively.
  • Smoking and chronic coughs - Constant coughing causes strain on your pelvic floor, weakening it.
  • Pelvic surgery - There is a risk with any pelvic surgery that damage can be done to the ligaments and muscles that support the bladder, urethra and pelvic floor.
  • Constipation - If you suffer from constipation you will often find yourself straining when you visit the bathroom, putting unnecessary pressure on your pelvic floor, leading to it weakening.

To read more about these causes, and the events that can lead to you developing any form of urinary incontinence, visit the Causes and Diagnosis page.


How to Stop Stress Urinary Incontinence

Here are the most common specific treatments for stress incontinence:

Conservative therapy's - Conservative therapy's, such as lifestyle changes and non-surgical medical treatments, resolve 25% of incontinence cases, and are the first course of treatment.

  • Pelvic floor (Kegel) exercises - The most important thing you need to do is reverse the damage to your pelvic floor and bring it back to full strength. Kegels (pelvic floor exercises) will help strengthen the muscles so they can better support your vital organs, giving you greater control. There are many other benefits of having a strong pelvic floor; such as an improved sex life, reduced bloating and improved bowel movements. Read more in our Pelvic Floor Exercise Hub.
  • Maintain a healthy weight - Reducing your weight by just 8% can decrease the frequency of your incontinence episodes by half.
  • Vaginal pessary - A silicone or rubber pessary device can be inserted into the vagina. It presses against the bladder neck and urethra to reduce leakage. Vaginal pessaries are commonly used to treat pelvic organ prolapses as they support the organs in their naturally elevated positions.

Surgery - Various surgical operations are available to treat stress incontinence which cannot be resolved, or sufficiently improved, by conservative therapy's or non-surgical medical treatments. The procedures available aim to tighten or support the muscles and structures below the bladder.

  • Colposuspension procedure - The urethra is stitched to ligaments at either side to elevate it as the pelvic floor naturally should.
  • Tension-free Vaginal Tape (TVT) procedure - A sling of synthetic (man-made) tape is surgically implanted to support the urethra and bladder neck as the pelvic floor naturally should. However, due to recent press and further studies, the National Institute for Health and Care Excellence currently only recommend using synthetic mesh within the context of research, as current evidence into the safety of using it is considered insufficient.

To read about the other treatments available for general urinary incontinence, and the potential complications associated with surgical treatments, visit our incontinence treatment page.


Sources

Al-Shaikh, G. Syed, S. Osman, S. Bogis, A. Al-Badr, A. (2018). International Journal of Women's Health. Pessary use in stress urinary incontinence: a review of advantages, complications, patient satisfaction, and quality of life. [online] 10(1), p195-201. [viewed 23/04/18]. Available from: https://www.dovepress.com/pessary-use-in-stress-urinary-incontinence-a-review-of-advantages-comp-peer-reviewed-article-IJWH

Dwyer, N. T. (2006). Urology Board Review Manual. Stress Urinary Incontinence in Women. Colposuspension for stress incontinence A Guide for Women

International Urogynecological Association. (2013). Colposuspension for stress incontinence: A Guide for Women. [online] International Urogynecological Association, 2013. [viewed 23/04/18] Available from: http://www.londonwomenscentre.co.uk/wp-content/uploads/2016/05/eng_colposuspension.pdf

Khandelwal, C. Kistler, C. (2013). American Family Physician. Diagnosis of Urinary Incontinence. [online] 87(8), p543-550. [viewed 23/04/18] Available from: https://www.aafp.org/afp/2013/0415/p543.html

Mota, R. L. (2017). International Brazilian Journal of Urology. Female urinary incontinence and sexuality. [online] 43(1), p20-28. [viewed 18/04/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293379/

NICE, (2013). Urinary incontinence in women: management. [online] National Institute for Health and Care Excellence, 2013. [viewed 18/04/18] Available from: https://www.nice.org.uk/guidance/cg171/resources/urinary-incontinence-in-women-management-pdf-35109747194821

NICE. (2017). Mesh for vaginal wall prolapse should only be used in the context of research, says NICE. [online] National Institute for Health and Care Excellence, 2017 [viewed 24/04/2018]. Available from: https://www.nice.org.uk/news/article/mesh-for-vaginal-wall-prolapse-should-only-be-used-in-the-context-of-research-says-nice

NHS. (2017). Your pregnancy and baby guide: Episiotomy and perineal tears. [online] NHS Trust, 2017. [viewed 18/04/18] Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/episiotomy/

Royal College of Obstetricians and Gynaecologists. (2005). Surgery for stress incontinence: information for you [online] Royal College of Obstetricians and Gynaecologists, 2005. [viewed 12/04/18] Available from: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/gynaecology/surgery-for-stress-incontinence.pdf