urinary incontinence

Urinary incontinence is the unintentional loss of urine. Stress incontinence happens when physical movement or activity — such as coughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder. Stress incontinence is not related to psychological stress. Stress incontinence differs from urge incontinence, which is the unintentional loss of urine caused by the bladder muscle contracting, usually associated with a sense of urgency. Stress incontinence is much more common in women than men.
If you have stress incontinence, you may feel embarrassed, isolate yourself, or limit your work and social life, especially exercise and leisure activities. With treatment, you'll likely be able to manage stress incontinence and improve your overall well-being.

If you have stress incontinence, you may experience urine leakage when you:

  • Cough
  • Sneeze
  • Laugh
  • Stand up
  • Get out of a car
  • Lift something heavy
  • Exercise
  • Have sex

You may not experience incontinence every time you do one of these things, but any pressure-increasing activity can make you more vulnerable to unintentional urine loss, particularly when your bladder is full.

When to see a doctor

Talk to your doctor if your symptoms interfere with daily activities, such as work, hobbies and social life. Stress incontinence occurs when the muscles and other tissues that support the bladder (pelvic floor muscles) and the muscles that regulate the release of urine (urinary sphincter) weaken.
The bladder expands as it fills with urine. Normally, valve-like muscles in the urethra — the short tube that carries urine out of your body — stay closed as the bladder expands, preventing urine leakage until you reach a bathroom. But when those muscles weaken, anything that exerts force on the abdominal and pelvic muscles — sneezing, bending over, lifting, laughing hard, for instance — can put pressure on your bladder and cause urine leakage.

Your doctor may have you fill out a questionnaire to make a preliminary assessment of your stress incontinence symptoms. You may also be asked to keep a bladder diary for a few days. In a bladder diary, you record when, how much and what kind of fluids you consume, as well as when and how much you urinate and when you experience incontinence episodes.
Your diary may reveal patterns that help your doctor understand your symptoms and identify contributing factors. This may reduce the need for more-invasive testing.
Specialized testing may require referral to a specialist in urinary disorders for men and women (urologist) or a specialist in urinary disorders in women (urogynecologist).


What to expect from your doctor

Be prepared to answer questions from your doctor. Questions your doctor might ask include:

  • How often do you leak urine?
  • When you leak urine, is it a few drops or are your clothes soaked?
  • Are there times when you know that you will leak?
  • Do you leak urine when you exercise?
  • Do you wake up during the night to urinate? How often?
  • What's your typical daily fluid intake?
  • Does anything seem to make your incontinence better? How about worse?
  • What bothers you most about your urinary incontinence?
  • Do you also have bowel leakage? How often? Does this cause you to restrict your activities?
  • Does it seem as if there's something "falling out" of your pelvis or vagina?
  • During your visit, your doctor looks for clues that may also indicate contributing factors. Your appointment will likely include a:
  • Medical history
  • Physical exam with particular focus on your abdomen and genitals
  • Urine sample to test for infection, traces of blood or other abnormalities
  • Brief neurological exam to identify any pelvic nerve problems
  • Urinary stress test, in which the doctor observes urine loss when you cough or bear down