Stress incontinence

Stress incontinence is an uncontrollable leakage of urine during physical exertion such as coughing, sneezing, laughing, or performing exercise. Stress incontinence is the most widespread manifestation of urinary incontinence. It is much more common in women than men.

About stress urinary incontinence

Stress incontinence (SUI) happens when there is external pressure or stress placed onto the bladder. This extra pressure causes the bladder to leak urine. How much urine is passed depends on the level of external pressure applied to the bladder. These external pressures are normally in the form of a strenuous physical activity like lifting a heavy object, performing vigorous exercise or even a simple cough, sneeze or giggle. Your prelvic floor muscles need to be strong enough to prevent this unintentional leakage of urine. So get working on this muscle group and within a very short time (usually within 3 months) you will be surprised how much more control you will have.

Stress incontinence is the most common form of urinary incontinence, affecting about 4% of the Australian population. It generally affects older women rather than younger women. As many as 1 in 5 women over 40 have some degree of stress incontinence.

What causes stress incontinence?

An easy way to imagine stress incontinence is to use an analogy. Picture yourself holding a water filled balloon. The narrow part of the balloon is squeezed shut by your fingers so that the water doesn’t trickle out. But if your fingers get weary, and you compress the balloon just a bit, the water will leak out. The balloon represents your bladder; your fingers represent your pelvic floor muscles and the pressure on the balloon represents some external physical force.

The more medical or technical definition of stress incontinence is that the sphincter muscle surrounding the urethra (the tube connecting your bladder to the outside world) and the pelvic muscles supporting the urethra are so weakened that pressure on the bladder causes these muscles to give way and allow small amounts of urine to leak from the bladder. Depending on your level of urinary incontinence, you might not suffer leakage of urine every time you cough, sneeze, laugh, etc. However, if your bladder is full when you perform a strenuous or sudden physical activity, your chances of experiencing some kind of urinary leakage are increased.

The main reason that women experience high levels of pelvic floor weakness is that the process of being pregnant and giving birth, tend to put a lot of extra pressure on the pelvic floor muscles. These muscles will only recover if you reactivate adn strengthen them. Menopause can also cause pelvic floor muscles to lose some of their elasticity and tone, making them less effective. If you have had a hysterectomy, your pelvic floor may also have been disrupted and need reinvigoration.

Being overweight, can also put extra pressure on your pelvic floor muscles making any stress incontinence much worse. So, plan to eat a healthy diet that focuses on a regular intake of good quality food that is varied and high in fibre, not just the quantity of food you consume. Whatever you do, don’t cut down on the amount of fluid you drink, this will only make you constipated.

Constipation will also make your stress incontinence worse. Constipation is when you experience a combination of:

  • bowel movements that are less than you usually pass
  • less than three bowel movements each week
  • you must work hard at pushing the stool (poo) out
  • your stool is dry and hard to expel

If you experience these symptoms for longer than 3-months this is known as chronic constipation. Chronic constipation and straining at stool for prolonged periods of time, reduces your pelvic muscle strength and puts pressure on your bladder making your stress incontinence worse.

If you have chronic constipation you will need to talk to your Pharmacist, Continence Nurse Advisor or GP as they will assist you in selecting the right laxative for you. Make sure your diet is high in fibre and that you drink well throughout the day. Fibre supplements are great but if you are not drinking enough fluid, they too can cause you to become bloated and constipated.

Prostate surgery can also cause stress incontinence in men. Removal of this enlarged gland reduces the supportive structures holding the urethral and bladder neck nice and tight. Again, by doing Pelvic Floor Exercises you too can tone and reduce those frequent and annoying leaks. More importantly you can speed up your rate of recovery by incorporating Pelvic Floor Exercises into your daily routine.

Urinary tract infections can also cause symptoms similar to stress incontinence. So it is really important to have your urine tested by your local GP.

Smoking can cause chronic coughing, and coughing contributes greatly to the advent of stress incontinence. If you quit smoking you will help stop that nagging chronic cough and fix those urinary leakages.

Getting diagnosed

Stress incontinence can be diagnosed in a variety of different ways. Generally, you would visit a Urologist or Urogynacologist who will do some specialised tests to ascertain if stress incontinence is a problem for you. One of these tests is a stress test. This is done by your doctor asking you to cough forcefully to see if any urine leaks out. Your urine should also be analysed to see if you have an infection. Urodynamic testing may also be performed. This examination creates a holistic picture of your bladder, urethra and pelvic floor muscle function. If you see a Continence Nurse Advisor or Continence Physiotherapist they may also perform a vaginal examination to test the strength of your pelvic floor muscles.

Your health practitioner, GP, Nurse or physiotherapist may also ask you to keep a ‘bladder diary’ to record how often you use the toilet and how much urine there is every time you go. This diary and your medical history will help your chosen health practitioner to diagnose your problem and at the very least enable the right diagnostic tests to be done. You can also use this diary to see how you are improving over time as you start strengthening your pelvic floor muscles.

Stress incontinence treatment

If you suffer from stress incontinence, you may feel self-conscious, keep to yourself or curtail your involvement in the professional and social aspects of your life. In seeking treatment for your stress incontinence, you will be able to again engage in a full and worry-free life.

The most important stress incontinence management techniques are:

  • Pelvic floor exercises / kegel exercises: Don’t wait till you experience stress incontinence, do them now! These exercises strengthen and improve the performance of your pelvic floor muscles and decrease the chance that stress incontinence will strike. An added benefit of doing pelvic floor exercises is that they improve your sex life, by making your orgasms stronger and more pleasurable. Now that is a benefit, isn’t it! 
  • Lifestyle changes: The wide variety of lifestyle changes are known to combat stress incontinence. They include:
    • Drinking more non-caffeinated fluids. Avoid coffee and alcohol as both increase your production of urine.
    • Only go to the bathroom when your bladder is full, avoid going just in case. This way your bladder gets used to holding a good amount of urine and does not scream at you when holding only little amounts.
    • Do not avoid activities that might lead to stress incontinence as this will only curtail your happiness. Practice doing your Pelvic Floor Exercises, build up your strength and enjoy jumping or running.
    • Definitely give up smoking, to avoid that dreadful chronic cough.
    • Try to lose some of that abdominal weight to keep those pressures on your bladder lower.
  • Incontinence surgery: There are surgical options for people with severe stress incontinence. See our page on Surgery for more information on this form of treatment.

Remember stress incontinence should not be viewed as a normal part of aging or an expected result of childbirth and it is definitely not something that you need to learn to live with. There are many solutions available to help you manage stress incontinence so that it does not impact on your everyday activities. You should speak to your doctor to get a referral to a medical specialist or you can see a Continence Nurse Advisor or Physiotherapist. All of these health professionals can help you map out a plan so you can manage your stress incontinence well.

Kimberly-Clark Australia makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional medical or other health professional advice.

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