Stress Incontinence: Everything You Need to Know

TEAM KNIX / YOUR BODY

According to the 2010 International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report, stress urinary incontinence is defined as voluntary loss of urine on effort, physical exertion, or on sneezing or coughing.

When SUI is more severe, even less stressful exertion (like standing up or bending over) can result in an involuntary loss of urine. Stress incontinence is considered the most common form of incontinence (there are 5 types of incontinence that impact women).

To learn everything you need to know about stress urinary incontinence (SUI), read on...

At-a-Glance: Stress Incontinence Stats

  • Urinary Incontinence affects 200 million people worldwide. (National Association for Incontinence)
  • Stress urinary incontinence (SUI) is variably estimated to affect between 4% and 35% of adult women. (NCBI)
  • About 1 in 3 women suffer from SUI or stress incontinence at some point in their lives. Urinary incontinence increases with age. Over half of women with SUI also have OAB (overactive bladder). (Urology Care Foundation)
  • The prevalence of daily stress incontinence is 10% in community dwelling middle aged women. (BMJ)
  • A third of women with stress incontinence report urine leakage weekly. (BMJ)
  • 50% of people afflicted with urinary incontinence do not seek help (Ian Milsom, Gothenburg Continence Research Center)

What Are the Symptoms of Stress Incontinence?

If you’ve ever peed a little when you’ve:

  • Sneezed
  • Coughed
  • Laughed
  • Been doing exercise
  • Or having sexual intercourse
  • While lifting something heavy or bending over

… those are symptoms of stress incontinence.

Stress incontinence occurs when the body is exerting and other muscles or muscle groups (in particular the pelvic floor muscles) become compromised or less effective at doing their job, which includes holding in pee.

What Causes Stress Incontinence?

Stress urinary incontinence (SUI), the most prevalent form of incontinence among women. It affects an estimated 15 million adult women in the U.S. And although it affects both men and women, it is twice as common in women as it is in men. The main reasons for this are pregnancy, childbirth and menopause.

Stress incontinence is caused when the pelvic floor muscles become weakened. This can happen due to aforementioned milestones in a woman’s life; like pregnancy, childbirth and menopause. But it can also happen due to:

  • Certain surgical procedures
  • Excessive straining from constipation or chronic coughing

You see, pelvic floor muscles are just like any other muscle; they can be injured and they can become weaker if not exercised. This is why pelvic floor exercises (or Kegel exercises) are so often recommended for women.

Think of it this way; if you hurt your arm or leg, or if they’re generally weak, you might find that it “gives” more easily under strain. The pelvic floor muscles can similarly fail if they are injured or weakened. The only difference is when they fail, it can result in urine leakage.

Other Risk Factors

In addition to the causes we’ve covered above, there are some factors that increase the risk of stress incontinence. They include:

  • Age
  • Being overweight
  • Smoking
  • Family history
  • Other diseases (e.g. diabetes, MS, Parkinson’s Disease)
  • Having been through pregnancy and childbirth
  • Having undergone certain pelvic surgeries (e.g. hysterectomy)

Pelvic Floor Muscles: Understanding the Anatomy of Peeing

Okay, you’ve been peeing all your life but unless you really aced biology, odds are you don’t really know what really happens when you pee. To truly understand what happens when the pelvic floor muscles fail, you really need to know what’s supposed to happen…

Your brain and bladder work together to control urinary function. 

The bladder is where urine is stored until you are ready to release it. And the muscles of your pelvis hold the bladder in place. The muscles of the bladder are usually relaxed and hold urine in the bladder and the neck of the bladder is closed. 

The urethra is the tube that carries urine from the bladder to outside the body. The sphincter muscles are closed around the urethra. When those muscles do their job, urine does not leak outside the body by accident.

When you are ready to pee, your brain lets the bladder know. This causes the bladder muscles to contract which forces urine out through the urethra. The sphincter also opens up, allowing a flow of urine to pass through the urethra and leave the body.

What Are Kegel Exercises & How Do They Help Stress Incontinence?

Kegel exercises are like any other form of exercise; they can strengthen your pelvic floor muscles when done habitually. This means you have to make a daily commitment to doing your Kegels.

Indeed, many would say that whether you experience stress incontinence or not, making a ritual of practicing pelvic floor exercises is a good preventative measure for incontinence or involuntarily passing gas. And while they don’t change the way you look, regular Kegels can even enhance your orgasms!

There’s more good news: You don’t need any special gear or attire to do Kegels. In fact, you can do them anywhere and nobody will know. You could be doing them right now as you’re reading this article. But it can be difficult to know how to do Kegels at first…

If you’re unsure how to do Kegel exercises, your doctor or physiotherapist can help you. But basically it’s like pretending you have to urinate and then holding it. You relax and tighten the muscles that control urine flow. 

One way to learn the muscles you should activate is to pay attention when you pee: Start to pee and then stop. You should feel the muscles in your vagina (for women), bladder, and anus get tight and move up. These are the pelvic floor muscles. 

If you feel them tighten, you have done the pelvic floor muscle training right. Your thighs, buttock muscles, and abdomen should remain relaxed while you’re doing the exercises.

Kegel exercises will not have an instantaneous impact on stress incontinence, or any other form of incontinence. So, in the meantime, you might want to find some more immediate ways to deal with the experience of stress urinary incontinence.

Lifestyle Products That Help You Manage Light Bladder Leaks Caused by Stress Incontinence

While you explore treatment options for stress incontinence with your healthcare provider, you can also explore products to help you stay active and social. Leakproof underwear comes with different absorbency levels, that can hold up to 8 tsp of pee. 

Super absorbent Knix leakproof underwear can hold up to 8 tsp of liquid (whether that’s sweat, blood or urine). Products like these can be a game changer for those experiencing female urinary incontinence, allowing them to remain active and social while exploring treatment options.

Other Treatment Options for Stress Urinary Incontinence

Half of women who experience incontinence do not discuss it with their doctor. But it’s always a good idea to discuss any changes in your body with your healthcare provider. Don’t worry about feeling embarrassed; stress incontinence is nothing to be ashamed of, and it’s something your doctor will be very familiar with.

What’s more: There’s more than one kind of incontinence, and while you might feel certain you’re experiencing stress incontinence, it’s still worth getting medical confirmation. Plus, there is always a chance - even slim - that it could be a symptom of something more serious.

When you do make the time to talk to your doctor, it helps to be prepared. Write down the questions you want to ask and anticipate the questions they might ask you!

Once your healthcare provider has diagnosed stress incontinence, they will discuss treatment options with you. As with many medical diagnoses, there will be a range of options for you to consider. 

In addition to treatments, your doctor may recommend certain lifestyle changes to help mitigate your risk of stress incontinence.

Lifestyle Changes that Reduce Risk Factors

If you are committed to avoiding more invasive procedures and want to explore lifestyle changes first, communicate this clearly with your doctor and make a plan to measure progress, which can be slower and less perceptible than with drugs and other treatments.

While you can’t undo past surgeries or childbirth, some of the factors that put you at risk of incontinence can be lessened by making considerable lifestyle changes. In particular, maintaining a healthy weight and quitting smoking are changes you may be able to commit to.

It’s worth committing to a healthy lifestyle more generally — not just to reduce risk of incontinence. But it’s also worth noting that a healthy lifestyle is no guarantee you won’t be affected by illness or medical concerns, including incontinence. 

Fluid Consumption & Bladder Training

Your healthcare professional may also recommend making changes to the fluids you consume, and when you consume them. Of course, it’s important to stay hydrated. But they may suggest cutting back on caffeinated, carbonated beverages and/or alcohol. If these simple changes have an effect, it will be a personal decision whether to make more permanent dietary changes.

In addition to curtailing certain beverages, your doctor may advise bladder training. This involves taking bathroom breaks at regularly timed intervals. By ensuring your bladder is emptied frequently, you minimize the chances of leakages. Over time, the time between breaks can be increased. This course of action might be especially effective for those with mixed incontinence.

Devices

Devices that can be used to control stress incontinence include vaginal pessaries and urethral inserts.

  • Vaginal Pessary: This is a soft, removable device that is inserted in the vagina. It supports areas that are affected by pelvic organ prolapse (POP).
  • Urethral Insert: A small tampon-like disposable device inserted into the urethra acts as a barrier to prevent leakage, while still allowing you to pee.

Surgery

Finally, under certain circumstances, your doctor may recommend surgery. These will usually help strengthen the bladder neck or improve closure of the sphincter. 

Surgical options include:

  • Sling procedure
  • Injectable bulking agents
  • Retropubic colposuspension

The sling procedure is the most  common surgical procedure performed in women with stress urinary incontinence. This procedure entails the surgeon using the person's own tissue, synthetic material, or donor tissue to create a ‘sling’ or hammock that supports the urethra. Learn more about it from the Mayo Clinic.

Surgery often offers a more long term solution to involuntary urine leaks.  However, as with any surgery, there are risks to explore and you might want to try  exploring other options before you undergo surgery.

How to Prepare to Talk to Your Healthcare Provider

We get it: It can be nerve wracking to think about chatting with your doctor about certain experiences and symptoms. It helps to prepare the questions you might like to ask them, as well as to be prepared for the questions they might ask you.

These are some of the questions your doctor may ask about your experiences of female urinary incontinence:

  • How long have you been experiencing these symptoms?
  • Have your symptoms been continuous or occasional, have they worsened over time?
  • When (time of day or night) do you leak urine?
  • How often do you need to urinate?
  • Is it difficult for you to empty your bladder?
  • Have you noticed any blood in your urine?
  • General lifestyle questions: Smoking, diet, alcohol and caffeine consumption etc.

And here are some questions you might ask your doctor:

  • What type of incontinence do I have?
  • What is causing my urinary incontinence
  • What tests should I expect?
  • Should I make lifestyle changes, like:
    • Bladder diary
    • Kegel exercises
    • Timed bathroom breaks
    • Dietary changes, etc.
  • What treatment(s) do you suggest for me and why?
  • Without treatment, what will happen?
  • What are the side effects or risks associated with this treatment plan?

Stress Incontinence Shouldn’t Ruin Your Life

Stress incontinence, or any kind incontinence like urge incontinence or mixed incontinence, can cause stress and embarrassment. But it really doesn’t need to ruin your life. 

There are products, like leakproof underwear, that can offer immediate protection and give you back your confidence. And between exercising your pelvic floor muscles and other treatments you and your healthcare provider might explore, you may see improvement in your experience over time.