The Urology Group
 
Conditions We Treat / Women’s Health / Female Incontinence

Stress Incontinence


Female IncontinenceMillions of women experience involuntary loss of urine, called urinary incontinence. The condition affects all ages and women of every social and economic level, though urinary incontinence occurs more often in older women than in young women. There are two basic forms of incontinence in women: urge incontinence and stress incontinence. This page covers stress incontinence.

Symptoms:

Urinary stress incontinence is evident when a sudden movement or activity, such as coughing, sneezing, laughing or lifting, causes abdominal pressure on the bladder, which triggers a small amount of urine to leak. Stress incontinence is the most common type of incontinence women suffer, especially older women. In addition, women who have given birth are more likely to have stress incontinence.

The leakage may be as little as a drop or two, or may be a "squirt," or even a stream of urine.

Causes:

Stress incontinence occurs when the muscle (sphincter) that holds the bladder’s outlet closed is not strong enough to hold back the urine.

Problems with the way the sphincter muscle opens and closes can also cause stress incontinence. Chronic coughing, smoking and obesity may also lead to the condition.

Stress incontinence, especially in women, is often caused by physical changes to the body, such as:

  • Pregnancy and childbirth
  • Menstruation
  • Menopause
  • Pelvic surgery
  • Problems with muscles in the bladder – the organ that holds urine – and the urethra
  • Weakened muscles around the bladder

In cases of stress incontinence, the muscles in the pelvis can weaken. This can cause the bladder to drop down into a position that prevents the urethra from closing completely. The result is a leakage of urine.

Diagnosis:

A physician will take a detailed history and perform a physical exam to categorize your incontinence. Additional testing may be required, including:

  • Voiding diary, in which the patient keeps a record of fluid intake and frequency of urination.
  • Urinalysis and culture testing to identify possible infection or blood in the urine.
  • Urodynamics, which is a special technique that measures pressure in the bladder and urine flow.
  • Post-void residual volume, which is a scan that measures the amount of urine left in the bladder after urination.

Treatment:

Conservative treatments:

  • Pelvic floor exercises.  Many physicians encourage new mothers to do Kegels (pelvic floor exercises) after giving birth. These exercises strengthen the muscles that control urination. You tighten, hold and then relax the muscles you use to start and stop the flow of urination, working up to three sets of 10 a day​.

  • Biofeedback. If you are having trouble locating the right muscles to squeeze and strengthen, you may benefit from biofeedback. This approach involves scheduled visits to our bladder control center, each lasting about one hour. A probe monitors the strength of your squeezing and allows you to view your progress on a computer screen, teaching you to more effectively repeat the exercises at home.
  • Incontinence pessaries. A pessary is a mechanical support device that is inserted into the vagina to support the urethra. When fitted properly, you don’t feel it inside and it stops the bladder from leaking. Some models look like a ring with a support knob, which can be left in for longer periods of time, including during sexual intercourse. Others look like tampons and are inserted similarly. They can be left in for up to 12 hours. 

Surgical treatments:

  • Midurethral synthetic sling. The most commonly performed procedure for stress urinary incontinence, surgical mesh in the form of a “sling” (sometimes called “tape”) is permanently implanted beneath the urethra to provide support. This is commonly referred to as a “sling procedure.”

  • Autologous fascial sling. The autologous fascial sling utilizes your own tissue, taken either from the abdominal region or the thigh, to create the sling that will be placed to support the urethra. Unlike midurethral slings, it is placed at the level of the bladder neck.

  • Urethral bulking agents.  A medication is injected inside the urethra to make the space around the urethra thicker, thus helping to control urine leakage, although the effects may not be permanent.

Additional Resources:

For more information on Female Incontinence visit WebMD's Incontinence & Overactive Bladder Health Center.

To record your urination patterns click here.

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