Stress incontinence is the most common form of incontinence. It means you leak urine with things like coughing, sneezing or exercise. It happens when the pelvic floor muscles that support the bladder are weakened. Childbirth is a common reason for a weak pelvic floor. The main treatment for stress incontinence is pelvic floor exercises. Surgery to tighten or support the bladder outlet can also help. Medication may be used in addition to exercises if you do not want, or are not suitable for, surgery.
The kidneys make urine continuously. A trickle of urine is constantly passing to the bladder down the ureters (the tubes from the kidneys to the bladder). You make different amounts of urine depending on how much you drink, eat and sweat.
The bladder is made of muscle and stores the urine. It expands like a balloon as it fills with urine. The outlet for urine (the urethra) is normally kept closed. This is helped by the muscles beneath the bladder that surround and support the urethra (the pelvic floor muscles).
When a certain volume of urine is in the bladder, you become aware that the bladder is getting full. When you go to the toilet to pass urine, the bladder muscle contracts (squeezes), and the urethra and pelvic floor muscles relax to allow urine to flow out.
Complex nerve messages are sent between the brain, the bladder, and the pelvic floor muscles. These tell you how full your bladder is, and tell the correct muscles to contract or relax at the right time.
Stress incontinence is when urine leaks because there is a sudden extra pressure within the abdomen and on the bladder. This pressure (or stress) is caused by things like coughing, laughing, sneezing or exercising (such as running or jumping). Weakened pelvic floor muscles cannot support the bladder and urethra so well. The pressure is too much for the bladder outlet to withstand and so urine leaks out. Small amounts of urine may leak, but sometimes it can be quite a lot and can cause embarrassment. The diagram below shows how the pelvic floor muscles support the bladder and nearby structures.
Stress incontinence is the most common form of urinary incontinence. It is estimated that about three million people in the UK are regularly incontinent. Overall this is about 4 in 100 adults, and well over half of these are due to stress incontinence. Stress incontinence becomes more common in older women. As many as 1 in 5 women over the age of 40 have some degree of stress incontinence.
It is likely that the true number of people affected is much higher. Many people do not tell their doctor about their incontinence, due to embarrassment. Some people wrongly think that incontinence is a normal part of ageing or that it cannot be treated. This is unfortunate as many cases can be successfully treated or significantly improved.
The second most common type of incontinence is urge incontinence which is dealt with in a separate leaflet. Briefly, urge incontinence is when you get an urgent desire to pass urine from an overactive bladder. Urine may leak before you have time to get to the toilet. Treatment is different to stress incontinence. Some people have both stress incontinence and urge incontinence. This is known as mixed incontinence.
There are other, less common types of incontinence.
Note: you should always see your doctor if you develop incontinence. Each type has different treatments. Your doctor will assess you to determine the type of incontinence and advise on possible treatment options. See the separate leaflet called 'Urinary Incontinence' for a general overview and to understand what is likely to happen during the assessment by your doctor. The rest of this leaflet is only about stress incontinence in women.
Most cases of stress incontinence are due to weakened pelvic floor muscles. Pelvic floor muscles are often weakened by childbirth. The pelvic floor muscles are a group of muscles that wrap around the underside of the bladder and rectum. Stress incontinence is common in women who have had children, particularly if they have had several vaginal deliveries. It is also more common with increasing age as the muscles become weaker, particularly after the menopause. Stress incontinence is also more common in women who are obese. Stress incontinence can occur in men who have had some treatments for prostate cancer. This includes surgical removal of the prostate (prostatectomy) and radiotherapy.
First-line treatment involves strengthening the pelvic floor muscles with pelvic floor exercises. About 6 in 10 cases of stress incontinence can be cured or much improved with this treatment. If you are overweight and incontinent then you should first try to lose weight in conjunction with any other treatments. Surgery may be offered if the problem continues and is a significant problem. Medication may be used in addition to exercises if you do not want, or are not suitable for, surgery.
It is important that you exercise the correct muscles. Your doctor may refer you to a continence advisor or physiotherapist for advice on how to do pelvic floor exercises correctly. Below are instructions you can follow yourself at home.
Learning to exercise the correct muscles:
Doing the exercises:
It takes time, effort and practice to become good at these exercises. It is advised that you do these exercises for at least three months to start with. You should start to see the benefit after a few weeks. However, it often takes 8-20 weeks for most improvement to occur. After this time you may be cured from stress incontinence. If you are not sure that you are doing the correct exercises, ask a doctor, physiotherapist or continence advisor for advice.
If possible, continue pelvic floor exercises as a part of everyday life forever, to stop the problem recurring. Once incontinence has gone, you may only need to do 1-2 five-minute repetitions each day to keep the pelvic floor muscles strong and toned up, and the incontinence away.
Sometimes a continence advisor or physiotherapist will advise extra methods if you are having problems performing the pelvic floor exercises. These are in addition to those described above. Examples include:
Various surgical operations are used to treat stress incontinence. They tend only to be used when the pelvic floor muscle exercises have not helped. The operations aim to tighten or support the muscles and structures below the bladder.
The tension-free vaginal tape (TVT) procedure is the name of an operation often used to treat stress incontinence. It involves a sling of synthetic (man-made) tape being used to support the urethra and bladder neck. Colposuspension is the name of another operation to support the urethra and treat stress incontinence.
If you have a vaginal prolapse, especially one called a cystocele, surgical repair of this weakness (called an anterior repair) is often performed to treat the associated urinary incontinence. See separate leaflet called 'Genitourinary Prolapse' for more information.
Other procedures involve injections of bulking agents around the bladder entrance, to keep it closed. These injections may be either natural materials (such as fat) or synthetic ones (such as silicone).
In general, surgery for stress incontinence is often successful. You can find more details on the different operations by looking at the website for the Royal College of Obstetricians and Gynaecologists, linked below under further help and information.
Duloxetine (brand names Cymbalta®, Yentreve®) is a medicine that is usually used to treat depression. However, it was found to help with stress incontinence separate to its effect on depression. It is thought to work by interfering with certain chemicals that are used in transmitting nerve impulses to muscles. This helps the muscles around the urethra to contract more strongly.
One study showed that in about 6 in 10 women who took duloxetine, the number of urine leakages were halved compared to the time before they took the medication. Therefore, on its own, duloxetine is not likely to cure the incontinence but may help to make it less of a problem. However, duloxetine in addition to pelvic floor exercises may give a better chance of curing the incontinence than either treatment alone.
Duloxetine may be advised if pelvic floor exercises alone are not helping to treat your stress incontinence. It is usually advised in women who do not want to undergo surgery, or in women who have health problems that may mean that surgery is unsuitable.
If you do regular pelvic floor exercises (as described above) during pregnancy and after you have a baby, then stress incontinence is less likely to develop following childbirth and in later life.
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A link to patient information on the surgical treatment of stress incontinence. The Royal College of Obstetricians and Gynaecologists website has a section dedicated to informing the public about women's health and issues relating to it.
If you are thinking of seeing a physiotherapist privately for incontinence, then members of this Association may be of particular help. Their website enables you to find a member of the Association nearest to where you live and gives some general information about issues such as incontinence and pelvic floor exercises. Note: physiotherapy for pelvic floor muscles is available on the NHS in most areas.