Stress urinary incontinence

Leaking urine when you laugh or sneeze can be embarrassing and inconvenient. At Atrium Health Floyd and Harbin Clinic, our experienced doctors have options for you. Whether you see a primary care provider, women’s health specialist or urologist, you’ll find the care you need and the compassion and respect you deserve.

What is stress urinary incontinence?

Stress urinary incontinence occurs when abdominal pressure on the bladder causes urine leakage. It is much more common in women than men.

Causes of stress urinary incontinence

Stress urinary incontinence is caused by physical changes in the tissues in and around your bladder and urethra. Your urethra starts at your bladder and drains urine from your body. A circular muscle (sphincter) in the urethra allows you to control the release of urine.

There are two main ways stress urinary incontinence happens, and both can happen at once:

• Muscles that support the bladder become weak, allowing the lower part of the bladder to move downward when pressed from above. This force makes it difficult for the sphincter to squeeze tightly enough.
• The sphincter muscle becomes weak and is unable to control the urine flow when abdominal pressure increases. If the sphincter is severely weakened, the leakage can be continuous.

Causes of stress urinary incontinence in women include:

• Aging
• Chronic cough
• Chronic constipation
• Diseases that affect the muscles and nerves
• Heavy lifting
• Obesity
• Prior pelvic or vaginal surgery
• Pregnancy and childbirth
• Traumatic injury

In men, stress urinary incontinence is usually a complication of prostate cancer surgery.

Stress urinary incontinence symptoms

The main symptom is urine leakage when abdominal pressure increases, such as when you:

• Cough
• Exercise
• Laugh
• Sneeze
• Yell

Stress urinary incontinence diagnosis

A detailed review of your symptoms and medical history is the first step in diagnosis. Your doctor will ask how often you leak urine and what activities trigger it. They may ask you to keep a voiding diary of your fluid intake and how often you urinate.

Your doctor may perform a physical exam (including a pelvic exam for women and genital exam for men) and a urinary stress test. This test looks for urine leakage when you cough.

Other tests your doctor may use to diagnose stress urinary incontinence include:

• Imaging tests to detect abnormalities in your urinary tract
• Post-void residual volume (PRV) test to measure how much urine is left in your bladder after you urinate
• Urinalysis to check for infections and underlying urinary conditions
• Urodynamic studies to measure urine flow and pressure inside your bladder

Stress urinary incontinence prevention

You can’t always prevent stress urinary incontinence, but maintaining healthy pelvic floor muscles with daily Kegel exercises can help. To do Kegel exercises:

• Contract your pelvic floor muscles
• Hold for three to five seconds
• Relax for three to five seconds
• Repeat 10 times, three times a day

Stress urinary incontinence treatment

There are many treatment options for stress urinary incontinence. Surgery can be effective, but most doctors recommend trying less invasive approaches first.

Nonsurgical treatments that can help control urine leakage include:

• Behavior changes: Try drinking less fluid, losing weight and avoiding triggering activities.
• Transurethral injections: Your doctor injects a bulking agent around the urethra to slow urine flow.
• Pelvic floor exercises: Kegel exercises improve pelvic muscle strength.
• Pelvic floor physical therapy: Pelvic floor physical therapy provides a more detailed evaluation of the pelvic floor muscles and exercises to strengthen them.
• Pessary: This device is inserted into the vagina to help support your bladder.
• Ultra Femme 360: This device uses radiofrequency energy to rejuvenate tissues in and around the vagina.

If you’ve tried other treatments and your condition still impacts your daily life, surgery may be the right choice for you. Surgeons use various procedures for stress urinary incontinence.

Urethral sling surgery is a common procedure that involves implanting a strip of tissue or mesh tape under the urethra to provide support. Men also have the option of replacing their urinary sphincter with an artificial one. Your doctor will review all your options for surgery, the benefits and risks, and what recovery looks like.

Related conditions

Incontinence