What Is Stress Incontinence? A Urogynecologist Explains

Leak a little pee when you cough, run, or sneeze? Here’s what to do about it.

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You’re at lunch with friends, catching up on the latest episode of The Bachelor, when all of a sudden you have a bit of a coughing fit and … OMG, did I just pee myself?!

“Usually the first episode of stress incontinence comes as a very big surprise,” says Lauri Romanzi, MD, a urogynecologist in New York City. “It will be when the bladder is quite full, near capacity. You might be feeling a lot of fullness, and then suddenly, have a cough.”

Stress incontinence occurs when your bladder leaks urine when it’s under increased pressure, such as when you exercise, lift something heavy,  sneeze, or when you’re having sex.

What Causes Stress Incontinence?

Stress incontinence can occur if the urethral wall, urethral sphincter, or pelvic floor muscles are weak, says Dr. Romanzi. Weakened pelvic floor muscles can cause the bladder to move downward, pushing the bladder slightly out of the bottom of the pelvis, which makes it difficult for the sphincter to squeeze tightly enough.

Stress incontinence is the most common type of incontinence in younger women, with the highest incidence occurring in women ages 45 to 49 years. Women who’ve been pregnant, given birth, gone through menopause, or are overweight or have diabetes are at an increased risk for stress incontinence. Prostate surgery can also cause stress incontinence in men.

“After a woman has a baby, she may temporarily have some problems controlling her bladder,” says Dr. Romanzi. She may feel symptoms of overactive bladder, stress incontinence, or a combination of the two, called mixed incontinence. Stress incontinence during and after pregnancy usually gets better on its own after a few months postpartum.

But, “women who have incontinence persisting six months after pregnancy may be in the group that’s going to have a permanent problem and they might want to seek treatment,” says Dr. Romanzi. (Here’s how to tell the difference between stress incontinence and overactive bladder.)

How Is Stress Incontinence Treated?

Treatment options for stress incontinence depend on how the symptoms affect your life, but they often include a combination of lifestyle or behavior changes, such as Kegel exercises. In more serious cases that haven’t gotten better with lifestyle changes, surgery is an option.

“Patients with stress incontinence can sometimes have significant improvement with non-surgical methods,” says Dr. Romanzi. “And the method of choice is Kegel exercise, which can be done formally in a pelvic floor physical therapy regimen, or it can be done on your own.”

Here’s how to do a Kegel exercise—and how NOT to do a Kegel exercise.

If you’ve tried self-treatment for three months and you’re not seeing results, go in and get help. “If [other treatments don’t] work, ultimately for stress incontinence you may have a surgical procedure,” says Dr. Romanzi.