Stress Incontinence in Women

What is stress incontinence?

Stress incontinence is leakage of urine during physical activities, such as exercise, coughing, sneezing, laughing, lifting, or sex. It is a common problem for women.

What causes stress incontinence?

The pelvic floor muscles normally fit snugly around the neck of the bladder. They form a ring of muscle that prevents urine from escaping through the urethra. The urethra is the tube that carries urine out of the bladder. The pelvic floor muscles can be stretched or torn during childbearing. After menopause there may be further loss of muscle tone because the lack of estrogen causes a thinning of tissues. Sudden pressure on the bladder (for example, from coughing or sneezing) can overcome the weakened muscles and cause some urine to escape.

A less common cause is pelvic surgery, which can either weaken pelvic muscles or damage pelvic nerves.

What are the symptoms?

Symptoms include leakage of urine during lifting or other physical activity, laughing, coughing, or sneezing.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Samples of your blood and urine will be tested. You may be referred to a specialist, such as a urologist or gynecologist, for further investigation and treatment. (A urologist is a healthcare provider who specializes in disorders of the urinary tract in both men and women and in the reproductive tract of men. A gynecologist specializes in women's healthcare and especially in disorders of the reproductive tract of women.)

How is it treated?

Weak pelvic floor muscles can often be strengthened by Kegel exercises. You can feel the muscles to use by squeezing the muscles in your genital area, for example, when you stop the flow of urine or try to stop from passing gas. To do Kegel exercises:

• Squeeze your pelvic floor muscles and hold the contraction for 4 seconds. Repeat this 10 to 20 times. Let the muscles relax completely between contractions.
• Do these sets of 10 to 20 contractions 3 to 4 times a day. You won't get as much help from the exercises if you do them less often than this.
• Do not do these exercises while you are urinating or having a bowel movement.

You can do Kegel exercises anywhere: while sitting at a desk, waiting for a bus, washing dishes, driving a car, waiting in line, or watching television. No one will know you are doing them.

You may see a change for the better after doing the Kegels for just a few weeks. However, you may not notice a lot of improvement until after 3 to 6 months of daily exercises. You should keep doing Kegels every day to keep the pelvic muscles strong.

Women may want to ask their healthcare provider about cones that may be used to help strengthen the pelvic floor muscles. The cones range in size. You may start with a large cone. You put it into your vagina and try to hold it in place for 15 minutes a couple of times a day. When this is easy for you to do, you may then try keeping a smaller cone in place.

Some medicines can help tighten the ring of muscles that control release of urine.

When symptoms are severe and attempts to strengthen these tissues with exercise or other medical treatments have not succeeded, surgery may be done to provide support to the bladder and the pelvic muscles.

How can I take care of myself?

• Tell your healthcare provider if you start having urinary incontinence. Follow your provider's advice for correcting or managing your incontinence.
• Do Kegel exercises regularly.
• Use incontinence pads to help catch urine leaks and protect your clothing. Be sure to change them regularly.
• Keep your groin area clean and as dry as possible.