What Is Stress Incontinence? A Urogynecologist Explains
Leak a little pee when you cough, run, or sneeze? Here’s what to do about it.
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.
Dr. Romanzi is a urogynecologist and reconstructive pelvic surgeon based in New York City.
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Usually, the first episode of stress
incontinence comes as a very big surprise.
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It will be when the bladder's
quite full and near capacity,
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you might be feeling a lot of fullness.
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And then suddenly have a cough.
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[MUSIC]
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This will often cause the first episode
of stress incontinence in people who
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are developing the condition.
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And they'll come in very upset and
concerned about this episode,
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and wondering if it's
going to happen again.
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Stress urinary incontinence is
formally defined as leakage of urine
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that occurs through the urethra
without a bladder contraction with
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increased pressure inside the abdomen.
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Typically, you increase your
abdominal pressure when you cough,
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when you sneeze, when you lift,
when you change position,
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when you pick up something heavy,
when you're running, when you're jumping.
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This is when you can
increase abdominal pressure.
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And if the sphincter's weak,
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you can have stress incontinence through
the urethra with no sense of urgency.
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People who are at risk for stress
incontinence are women after they've had
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babies, men after radical prostatectomy,
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women after menopause, and
diabetic overweight women.
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After a woman has a baby, temporarily she
may have some problems controlling her
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bladder that may be stress incontinence,
may be overactive urge incontinence,
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some combination thereof.
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Women who have incontinence
persisting six months
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after pregnancy may be in the group
that's gonna have a permanent problem.
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And they might want to seek treatment.
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Even patients with severe stress
incontinence can sometimes have
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significant improvement
with non-surgical methods.
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And the method of choice is Kegel
exercise, which can be done formally in
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a public floor physical therapy regimen,
or it could be done on your own.
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But if it doesn't work then,
ultimately, for stress incontinence,
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you may have a surgical procedure.
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Three months of self-treatment is enough.
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If you're not getting results,
go in and get some help.
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Bladder Control Problems in Women (Urinary Incontinence). National Institute of Digestive and Kidney Diseases. (Accessed on April 10, 2018 at https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-women) Stress Urinary Incontinence. U.S. Library of Medicine, MedlinePlus. (Accessed on April 10, 2018 at https://medlineplus.gov/ency/article/000891.htm)
Evaluation of women with urinary incontinence. UpToDate. (Accessed on April 10, 2018 at https://www.uptodate.com/contents/evaluation-of-women-with-urinary-incontinence)