Stress urinary incontinence (SUI) is a prevalent condition that affects millions of individuals worldwide, particularly women. Although it's common, it can be a significant source of discomfort and embarrassment for anyone who experiences it. To help you better understand the symptoms and treatment options, here's everything you need to know about stress incontinence.
What is Stress Incontinence?
Stress incontinence is a common type of urinary incontinence. It happens when urine leakage occurs after pressure is applied to the bladder. This typically has nothing to do with mental stress, strain, or anxiety. Instead, stress incontinence occurs due to abdominal pressure when you laugh, cough, sneeze, run, or lift heavy objects. It can also be paired with a feeling of needing to use the bathroom, but it's different from urge incontinence.
Symptoms of Stress Incontinence
The main symptom of stress incontinence is involuntary urine leaks that occur when you:
- Laugh
- Cough
- Sneeze
- Bend over
- Lift heavy objects
- Have sex
- Exercise
These activities all put pressure on the bladder, which can trigger an episode of stress incontinence. However, you may not leak urine every time you perform one of these actions. You're also more likely to experience leaks when you have a full bladder.
How Common is Stress Incontinence?
Stress incontinence is the most common type of urinary incontinence, but it's more common in women than in men. This is often due to anatomical differences and the intra-abdominal pressures associated with pregnancy and childbirth. About 1 in 3 people assigned female at birth (AFAB) will experience stress incontinence at some point in their life.
How is Stress Incontinence Different from Other Types of UI?
There are several types of urinary incontinence, all of which result in the loss of bladder control. Some types of incontinence occur from muscle spasms in the bladder, while mobility issues or neurogenic conditions may cause others. The other types of urinary incontinence include:
- Urge Incontinence: A sudden, intense urge to urinate followed by involuntary loss of urine.
- Mixed Incontinence: A combination of stress and urge incontinence.
- Functional Incontinence: Urine leakage occurs because a physical or mental impairment prevents timely access to a toilet.
- Overflow Incontinence: An involuntary release of urine due to too much urine in the bladder that cannot be emptied completely, often leading to frequent dribbling.
What Causes Stress Incontinence?
Stress incontinence happens due to weakening pelvic floor muscles, which are the muscles that support the urethra and bladder. It's also associated with weakened urinary sphincter muscles, which control the release of urine when it's time for you to use the bathroom. Although aging can be a big contributor to weakening pelvic floor muscles, it's not the only cause.
Normally, the bladder expands when it fills with urine, and the liquid is contained thanks to the valve-like muscles of the urethra (the tube that carries urine from the bladder out of the body). When you get the urge to urinate, the process is voluntary, and no leaks occur. However, the urinary system has difficulty maintaining bladder control when the urethral or pelvic floor muscles weaken.
Stress incontinence in women or people assigned female at birth can occur for a variety of reasons. One of the most notable causes is childbirth. During delivery, the nerves in the urinary system can become damaged, and the pelvic floor muscles or sphincter can weaken. This can become apparent either immediately following delivery or years later. This is usually more noticeable in women who have had a vaginal delivery than cesarean sections. Having multiple children also increases your risk. Furthermore, decreased estrogen levels during menopause can also thin and weaken the tissues in the urethra and bladder, resulting in incontinence.
Stress incontinence in men or people assigned male at birth is most commonly associated with prostate cancer surgery. The surgery can weaken the sphincter and cause urine to leak. Additionally, surgery for an enlarged prostate (benign prostate hyperplasia) will remove unnecessary pressure on the urethra, but there's still a risk of developing SUI.
Other causes of stress incontinence for all genders may include things like:
- Illness
- Injury to the urethra
- Injury around the urethra
- Surgery to areas in proximity to pelvic organs
- Conditions that cause frequent coughing
- Certain medications
- Being overweight or obese
- Pelvic prolapse
- Chronic constipation and straining
Sometimes, the cause for people with stress incontinence is unknown. Treatment should still be able to help prevent urine leakage, but it's important to work with your urologist or doctor to find what works for you.
Risk Factors for SUI
The following factors can increase your risk of experiencing stress incontinence. If you're at risk or have symptoms, work with your urologist to take a proactive approach to care for your urinary tract. Some risk factors include:
- Age
- Body weight
- Pregnancy and childbirth
- Menopause
- Nerve injuries
- Pelvic surgery
- Chronic counting from underlying conditions
- Diabetes
Complications of Stress Incontinence
The primary complication of stress incontinence is the emotional distress that it can create. The stress or anxiety associated with stress incontinence can cause some people to avoid social situations or limit travel. It can decrease physical activity levels due to fear of leakage and get in the way of intimacy or relationships. Stress incontinence may also be a symptom of an overactive bladder, which can result in a variety of other symptoms, like an urgent need to use the bathroom or increased frequency.
When left untreated or unaddressed, any incontinence can increase the risk of skin rashes or ulceration. This is often caused by prolonged exposure to urine, which irritates the skin and can disrupt its protective barrier. However, incontinence products can help reduce this risk and increase comfort levels throughout everyday life.
Diagnosing Stress Incontinence
As you get older, the muscles supporting your bladder and urethra naturally weaken. However, incontinence is not a normal part of aging. If you're experiencing any symptoms of SUI or other types of incontinence, schedule an appointment with your doctor. They may perform a physical exam and imaging tests to determine the cause of your symptoms. Some other diagnostic tools include:
- Urinary pad test
- Urinalysis
- Bladder ultrasound
- Pelvic or abdominal ultrasound
- Cystoscopy
- Urodynamic testing
How to Manage and Treat Stress Incontinence
Stress incontinence may be mild to severe, but with the right treatment, you can regain confidence and improve your quality of life. Some of the most common stress incontinence treatments include the following:
Lifestyle Modifications
Your doctor will first discuss your current habits, routines, and diet. They may recommend working towards healthy weight loss, which can be particularly effective in managing stress incontinence. If you have a chronic cough, diagnosing and treating the condition causing it can also help improve urinary control. Other lifestyle modifications include reducing alcohol and caffeine intake and quitting smoking.
Pelvic Floor Exercises
Pelvic floor exercises like Kegels can strengthen the pelvic floor muscles, providing better support to the bladder and urethra. This can help reduce or eliminate leaks caused by stress incontinence. If you're not sure how to perform these exercises, talk to your doctor about recommendations for pelvic floor physical therapy. This may be more effective, as it can incorporate biofeedback to ensure that you're targeting the right area to strengthen the muscles you need for bladder control.
Bladder Training
Bladder training involves scheduling bathroom visits at specific times throughout the day, usually once every two hours. Then, over time, you can gradually increase the time between voiding to help improve bladder control. Although this may be more beneficial for other types of incontinence, your doctor may recommend keeping a bladder diary and utilizing training if you show signs of mixed incontinence.
Vaginal Pessary
People assigned female at birth can try addressing incontinence with a vaginal pessary. This is a device inserted into the vagina to support the bladder and reduce pressure on the urethra, helping to prevent urine leakage during physical activity. Although your healthcare provider will put the pessary in place, it does need to be removed and cleaned regularly.
Bulking Agents
Bulking agents, often made of gel or other material, can be injected to thicken the area around the urethra, helping it close more effectively and reducing urine leakage.
Surgical Intervention
There are also a few different surgical options that can be performed. The most common include:
- Sling Procedures: A minimally invasive surgery where a sling is placed under the urethra to provide additional support.
- Colposuspension: This procedure lifts and secures the bladder neck and urethra to the pelvic bone.
- Artificial Urinary Sphincter: This creates a cuff that sits at the upper part of the urethra which can be controlled by a pump that's placed in the scrotum.
Keep in mind that there are currently no approved oral medications for the treatment of stress incontinence in the US. However, Byram Healthcare is committed to creating supportive, informational solutions for individuals with urologic conditions. We understand the challenges of these conditions and strive to empower our customers with the knowledge and resources they need to manage their health effectively. That's why we carry several high-quality incontinence products to help manage symptoms and improve your quality of life.
