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Stress incontinence

Urinary incontinence is the unintentional loss of urine. Stress incontinence happens when physical movement or activity — such as coughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder. Stress incontinence is not related to psychological stress.

Stress incontinence differs from urge incontinence, which is the unintentional loss of urine caused by the bladder muscle contracting, usually associated with a sense of urgency. Stress incontinence is much more common in women than men.

If you have stress incontinence, you may feel embarrassed, isolate yourself, or limit your work and social life, especially exercise and leisure activities. With treatment, you'll likely be able to manage stress incontinence and improve your overall well-being.

Symptoms Causes Risk factors Complications

If you have stress incontinence, you may experience urine leakage when you:

  • Cough
  • Sneeze
  • Laugh
  • Stand up
  • Get out of a car
  • Lift something heavy
  • Exercise
  • Have sex

You may not experience incontinence every time you do one of these things, but any pressure-increasing activity can make you more vulnerable to unintentional urine loss, particularly when your bladder is full.

When to see a doctor

Talk to your doctor if your symptoms interfere with daily activities, such as work, hobbies and social life.

Stress incontinence occurs when the muscles and other tissues that support the bladder (pelvic floor muscles) and the muscles that regulate the release of urine (urinary sphincter) weaken.

The bladder expands as it fills with urine. Normally, valve-like muscles in the urethra — the short tube that carries urine out of your body — stay closed as the bladder expands, preventing urine leakage until you reach a bathroom. But when those muscles weaken, anything that exerts force on the abdominal and pelvic muscles — sneezing, bending over, lifting, laughing hard, for instance — can put pressure on your bladder and cause urine leakage.

Your pelvic floor muscles and urinary sphincter may lose strength because of:

  • Childbirth. In women, poor function of pelvic floor muscles or the sphincter may occur because of tissue or nerve damage during delivery of a child. Stress incontinence from this damage may begin soon after delivery or occur years later.
  • Prostate surgery. In men, the most common factor leading to stress incontinence is the surgical removal of the prostate gland (prostatectomy) to treat prostate cancer. Because the sphincter lies directly below the prostate gland and encircles the urethra, a prostatectomy may result in a weakened sphincter.

Contributing factors

Other factors that may worsen stress incontinence include:

  • Illnesses that cause chronic coughing or sneezing
  • Obesity
  • Smoking, which can cause frequent coughing
  • Excess consumption of caffeine or alcohol
  • High-impact activities over many years
  • Hormonal deficiency

Factors that increase the risk of developing stress incontinence include:

  • Age. Although stress incontinence isn't a normal part of aging, physical changes associated with aging, such as the weakening of muscles, may make you more susceptible to stress incontinence. However, occasional stress incontinence can occur in women of any age.
  • Type of childbirth delivery. A delayed second stage of labor (when the woman is "pushing"), as well as multiple vaginal deliveries, is associated with higher rates of the later development of stress incontinence. Many of these women may also have forceps delivery to more rapidly deliver a healthy baby — forceps delivery may also be associated with a greater risk of stress incontinence.
  • Body weight. People who are overweight or obese have a much higher risk of stress incontinence. Excess weight increases pressure on the abdominal and pelvic organs. As a result, the pressure on the bladder may be increased even without the additional pressure from a cough or other force. Weight loss can improve stress urinary incontinence.
  • Previous pelvic surgery. Hysterectomy in women and particularly surgery for prostate cancer in men can alter the function and support of the bladder and urethra, making it much more likely for a person to develop stress incontinence. This effect can be either immediate or delayed.

Complications of stress incontinence may include:

  • Personal distress. If you experience stress incontinence with your daily activities, you may feel embarrassed and distressed by the condition. It can disrupt your work, social activities, interpersonal relationships and even your sex life. Some people are embarrassed that they need pads or incontinence garments.
  • Mixed urinary incontinence. Mixed incontinence is common and means that you have both stress incontinence and urge incontinence — the loss of urine resulting from an involuntary contraction of bladder muscles (overactive bladder).
  • Skin rash or irritation. Skin that is constantly in contact with urine is likely to be irritated or sore and can break down. This happens with severe incontinence if you don't take precautions, such as using moisture barriers or incontinence pads.
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