Stress vs Urge Incontinence

If you experience an involuntary loss of urine, or incontinence, one of your first questions will be “why?” This will likely lead you down the complicated, and often confusing, path of learning about the different kinds of female urinary incontinence.

In fact, there are 5 different types of urinary incontinence that women can experience (learn more about the 5 kinds of female urinary incontinence here). The most common kind of incontinence is stress incontinence, followed by mixed incontinence and urge incontinence.

In this article, we’ll look more closely at stress and urge incontinence, as well as mixed incontinence, which is a combination of urge and stress incontinence.

Stress Incontinence vs Urge Incontinence

It would be easy to think that all incontinence is the same; after all, it all results in involuntary urine leakage. But the reasons that this may happen can be very different and can have different causes, and therefore different treatments.

Before you decide what to do about incontinence, it’s important to understand what type of incontinence you have. This will usually involve a visit to your doctor’s office.

At-a-glance, here’s a high level overview of stress incontinence and urge incontinence.

Learn more about other types of incontinence here.

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 urinary incontinence (SUI) has nothing to do with emotional stress, but is about physical exertion. The kinds of bodily ‘stressors’ that can result in stress urinary incontinence include:

• Laughing
• Sneezing
• Coughing
• Exercise
• Sexual intercourse
• Lifting something heavy or bent over

When any of those exertions cause an involuntary loss of bladder control, we’re talking about stress incontinence. And the cause is generally weakened muscles that become weaker when the body is experiencing the ‘stress’ of those exertions, so fails to hold in your pee.

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.

Treatment Options for Stress Incontinence

Treatment options for stress incontinence include:

• Lifestyle changes to reduce risk factors
• Pelvic floor exercises (Kegel exercises) to strengthen the pelvic floor 
• Changes to fluid consumption to reduce carbonated, caffeinated or alcoholic beverages
• Bladder training
• Devices like vaginal pessaries or urethral inserts
• Surgery, Surgical options include: sling procedure, injectable bulking agents, retropubic colposuspension

Urge Incontinence

For some people, a strong and sudden urge to urinate comes seemingly out of nowhere. It can happen even if they’ve urinated recently and or felt completely normal just a minute ago. And if they can’t get to a bathroom in time, an accident may happen. This is urge incontinence.

Because of its unpredictability it can be a very difficult form of incontinence to live with. The challenge here is often about how your brain and your bladder are communicating. There can be false messages that the bladder is full and needs emptying. Or “too late” messages that you need to urinate.

Urge incontinence has many possible causes, including a lot of the same causes we explored with stress incontinence. But because it also involves the brain, it can be linked to neurological conditions like Parkinson’s Disease and Multiple Sclerosis. 

However, It can also be caused by pregnancy (which puts pressure on the bladder), childbirth, menopause or trauma from surgery. And urge incontinence may also be caused by an overactive bladder (OAB) - though it’s important to note that OAB does not always cause incontinence and is not itself considered a disease. OAB can be caused when the muscles in your bladder are too active.

Treatment Options for Urge Incontinence

Treatment options can include biofeedback therapy, which seeks to give you greater awareness of your body’s physiological responses. Exercises to strengthen the urinary muscles (i.e. Kegels) can help too - while they won’t eliminate the urge, they can help ensure it doesn’t lead to a leak. 

• Biofeedback therapy
• Pelvic floor exercises (Kegel exercises) to strengthen the pelvic floor muscles
• Surgery

What Is Mixed Incontinence?

Mixed incontinence is when a person experiences both urge and stress incontinence. It’s not uncommon to experience both issues with bladder muscle control. It is, in fact, the second most common form of incontinence in women. If you have mixed incontinence, you likely have weakened pelvic muscles in combination with other possible health concerns that lead to urine leakage.

Are There Risk Factors for Urinary Incontinence?

30-60% of women over the age of 40 experience urinary incontinence (Ian Milsom, Gothenburg Continence Research Center) so if you are among them, you shouldn’t blame yourself. Being a woman does put you at greater risk (though as we’ve discussed, men can be impacted too). Your age puts you at greater likelihood.

In addition to these factors, urinary incontinence risk factors include:

• 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)
• Dementia 

Living with Urinary Incontinence: Lifestyle Changes and Solutions

Whether you’re experiencing stress, urge or mixed incontinence, it can cause anxiety 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.

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.

Don’t Be Afraid to Talk to Seek Medical Advice

Shockingly, 50% of people who experience any type of incontinence do not seek help. So while lifestyle changes are easy to make, we’re not at all suggesting they replace medical advice. If you’re experiencing incontinence, we definitely recommend bringing it up with your healthcare provider. They'll be able to confirm the kind of incontinence you're experiencing, as well as outline treatment options.

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! We covered a list of questions you might ask, as well as some questions your doctor may ask you, here.