What is stress incontinence?

Stress incontinence is when urine leaks out at times when your bladder is under physical pressure for example if you laugh or cough, run, sneeze or lift something heavy. Stress incontinence occurs is much more common in women than in men.

The condition can impact your mental health, you may at times feel embarrassed, isolate yourself, or limit your social and work life, especially leisure and exercise activities.

What are the causes of urinary incontinence?

It’s usually the result of either damage to the muscles such as the urethral sphincter or pelvic floor muscles used to prevent urination or the weakening of them.

The bladder expands as it fills with urine. Usually, valve-like muscles in the urethra stay closed as the bladder expands. It prevents urine leakage until you reach a toilet.

However, if these muscles weaken, anything that adds pressure on the pelvic and abdominal muscles can cause pressure on your bladder and cause you to leak urine.

Factors that can increase the risk of developing stress incontinence can include the weakening of muscles. If you’re obese or overweight, the excess weight can increase pressure on the abdominal and pelvic organs.

Prostate surgery is one of the most common causes of stress incontinence in men. When the prostate gland is removed (prostatectomy) to treat prostate cancer this may result in a weakened sphincter.

In women, childbirth can weaken the pelvic floor muscles or the sphincter can weaken because of nerve or tissue damage during the delivery of a child. Stress incontinence from this can occur years later or soon after the birth of the child. Hysterectomies can also cause stress incontinence. Some connective tissue disorders (for example Ehlers Danlos syndrome) and neurological conditions that affect the spinal cord and brain can also cause urinary incontinence.

How can stress incontinence be treated?

Strategies

There are a variety of treatment strategies to end or reduce the number of incontinence episodes.

• Pelvic floor muscle exercises – These movements can strengthen your pelvic floor muscles and urinary sphincter.
• Changes to lifestyle – Losing excess weight, treating a chronic cough and quitting smoking, for example, can lessen episodes of stress incontinence
• Training your bladder – Scheduling times to empty your bladder can reduce the severity or number of incontinence episodes.
• Fluid consumption – You may be recommended a certain amount and be given times when you’re allowed to.
• Medication – If you’re unsuitable for surgery or want to avoid having an operation, you may benefit from a medication called duloxetine.
• Devices – Certain devices designed for women may help control stress incontinence

Various surgeries can be carried out to treat stress incontinence, these include colposuspension, sling surgery and vaginal mesh surgery.

Other options can include Urethral bulking agents for women which increases the size of the urethra so it stays closed with more force. An artificial urinary sphincter can also help relieve incontinence.