It’s a problem that plagues millions of individuals around the world, but those who suffer from stress incontinence often suffer in silence. Many adults are too embarrassed to seek help for their occasional stress incontinence, and they often turn to folk remedies and over the counter incontinence products. Sadly, even when sufferers do speak with their doctors, they often find that the options out there are not satisfactory, or do not work for them.
The first thing you need to know about stress incontinence: you are not alone. In fact, the NHS (National Health Service) estimates that there are currently between 3 – 6 million Britons with varying degrees of urinary incontinence (NHS England, 2018). Approximately 24% of older adults experience some form on urinary incontinence, and it is nothing to be ashamed of. Over time, our bodies and physiology change, and it is impossible to expect everything to work the way it did when we were younger.
If you are experiencing any form of stress incontinence, you likely have many questions on your mind. We have compiled this informative and comprehensive guide to everything you need to know about stress incontinence.
What Is Stress Incontinence?
The NHS defines stress incontinence as, “when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh.” (NHS Choices, 2018). This stress could be caused by a sudden cough, a sneeze, a brisk run or even a bit of heavy lifting. All of these actions can cause a small (or even a large) amount of urine to leak from the urethra.
While some people hear the word ‘stress’ and assume that this term refers to the psychological state of mind, it actually has nothing to do with being ‘stressed out.’ It refers instead to the pressure (stress) that these activities put on your bladder.
Stress incontinence is different from urge incontinence. Urge incontinence is a different condition, caused by your bladder muscles contracting when you feel that you urgently have to urinate. Your urethra may begin to spasm, and if the muscles are not strong enough, urine can leak.
While stress incontinence tends to affect women much more often than men, urge incontinence is more equally spread across the sexes (Nitti, 2001). That said, due to physiological differences, women suffer from all forms of incontinence at a higher prevalence than men; 11% to 3 %, respectively, with urge incontinence accounting for 40% to 80% of the male patients.
Those who experience stress incontinence often report feeling embarrassed, isolated, unable to enjoy social events and holidays, and reluctant to attend the gym or other leisure activities. These feelings are why seeking treatment is so very important – no one should feel unable to enjoy life simply because of a common condition, about which there is nothing to be ashamed.
What Are The Symptoms Of Stress Incontinence?
Passing varying amounts of urine when doing or experience any of the following:
• at any point during or after a pregnancy
• standing for too long
• lifting heavy object
• during intercourse
What Are The Causes and Risk Factors of Stress Incontinence?
There are many different reasons why an individual might suffer from varying degrees of stress incontinence. Here we cover some of the most common.
Pregnancy – Many women will experience stress incontinence at some point during their pregnancies, often finding that they ‘leak’ a little more often than usual. Pregnancy can affect and interfere with your urethra’s normal functions, preventing it from contracting to ‘turn off’ the flow of urine. Some factors that can increase your risk of experiencing stress incontinence include a family history, advanced maternal age, and having a high body mass index.
Prostate surgery – Many men who undergo prostate surgery report experiencing some degree of stress incontinence in the months and years afterwards. The prostate surgeries (and other cancer treatments) can damage the nerves and muscles of the bladder and urethra, meaning that urine can easily escape.
Illnesses involving chronic coughing or sneezing – While exercising some muscles is good for them, when it comes to the bladder and urethra, this is not the case. Chronic illnesses that cause coughing or sneezing put constant pressure on the urethra, and for some, eventually, it can no longer do its job properly.
Smoking – Scientific studies have shown that women who smoke are three times more likely to experience stress incontinence (as well as urge incontinence) (Everyday Health, 2011). Urogynaecologist Dr. Sharon Knight states, "some explanations have been proposed, such as nicotine-induced bladder contractility and some other toxins that can be bladder irritants.” A smoker’s cough could also contribute to the problem.
High impact activities such as running / jumping over many years – High impact, high intensity workouts can wreak havoc on your bladder. A recent report by the Independent points to Box Jumps, Double Unders and Deadlifts as the biggest culprits (Hosie, 2017).
Age - As we get older, all of our muscles begin to get weak and do not perform the way that they once did. This is just as true for your bladder’s sphincter as it is for your biceps! As this muscle gets weaker, urine can escape more easily.
Type of childbirth delivery – Women who undergo an episiotomy (who are cut between their vagina and perineum to aid in childbirth) are far more likely to experience stress incontinence than others. The bladder and urethral muscles need to time to heal, and even once they do, they are usually never as strong as they once were.
Body weight – A higher than average BMI places undue pressure on the lower organs of the body, and this includes the bladder. Over time, this extra weight can stretch and wear the muscles of the bladder and urethra, leading to stress incontinence.
A past pelvic surgery – Any type of pelvic surgery can have an effect on the muscles of the bladder and urethra, weakening them and potentially causing instances of stress incontinence of varying severity.
What Are The Treatments For Stress Incontinence?
Pelvic floor exercises –These are meant to strengthen the muscles of your pelvic floor and prevent the leakage associated with stress incontinence.
How do you do pelvic floor exercises?
- Locate the correct muscles – If you want to locate your pelvic floor muscles, you simply need to halt your urination while you are mid-stream. Now that you know where they are, you can do these exercises anywhere, any time.
- Work on your technique – Tighten the muscles, and hold in for a full 5 seconds. Then, relax for 5 more seconds. Do this 5 times in a row. Once you are a pro at this set, increase the timing to 10 seconds, 10 times in a row.
- Isolate the muscles - Over time, you should focus specifically on tightening only your pelvic muscles, not those in your buttocks or abdomen. Remember – don’t hold your breath; you should breathe as normal the entire time.
- Do the entire cycle 3 times throughout the day - You will experience the best results if you do 10 sets, 3 times a day.
Biofeedback – The University of California has conducted studies that show that biofeedback can successfully treat stress incontinence. Biofeedback is a technique that uses audible sounds and computer images to let you know when you are exercising the correct muscles. This can really help an individual to locate their pelvic floor muscles.
Electrical stimulation – If you have tried the above methods and still cannot locate or contract your pelvic floor muscles, then your doctor might recommend trying electrical stimulation. A small electrical probe will be inserted into the vagina or anus, and the current can help to strengthen the muscles.
Vaginal cones – These are also devices that can help strengthen the pelvic floor. Also known as vaginal weighting, this medical device is shaped correctly to strengthen the muscles and restore normal bladder function.
Medication – Medication options for stress incontinence are not fully effective, so your doctor might jump directly to suggesting surgery if lifestyle changes do not ease the problem. However, some people might benefit from duloxetine. This medication can help to build the muscle tone in the urethra, enabling it to stay closed.
Surgery – If all of the above methods fail to achieve results, your doctor might suggest surgery. There are five main types of surgery performed on individuals with stress incontinence (NHS Choices, 2018):
- Tape procedures – Plastic tape is inserted inside the vagina and looped back out through the urethra. This tape helps to support the urethra.
- Colposuspension – In this surgical option, the neck of your bladder is accessed through your lower abdomen, and it is then lifted and stitched into this position. This can also be done laparoscopically.
- A sling procedure – In these procedures, a synthetic sling is placed around the neck of the bladder. This supports it, and prevents leaks. Some slings can also be made from your own tissue, donated tissue or other mammal tissue.
- Urethral bulking agents – This is a less invasive option for those who want to avoid surgery. A urethral bulking agent is injected, allowing the urethra to close with more force and therefore stay closed.
- An artificial urinary sphincter – If your urinary sphincter is failing, you can have an artificial one fitted. This treatment is usually only used for men.
Complications from stress incontinence
If you neglect to treat your stress incontinence with one of the above treatments, you are likely to face at least one (or a combination) of the following complications.
• Skin problems – When you release acidic urine into your undergarments, the moisture and bacteria pressing against the sensitive skin of your genitals and inner thighs can cause chafing, a severe rash, and even more serious skin infections over time. Make sure that you use adequate incontinence products in order to absorb the urine and keep yourself dry.
• Urinary tract infections – A UTI is an infection that causes a burning, painful sensation in the urethra, alongside an increased sense of urgency and the feeling of needing to empty one’s bladder even when it is empty. While they can have many causes, stale urine left sitting in and around the urethral opening can trigger bacterial overgrowth and a result in infection.
• Impact on personal life – Every aspect of your life can be impacted by stress incontinence. The fear of embarrassment and leakage can cause individuals to avoid social events, exercise, holidays and romantic intimacy.
• Personal distress – It can feel terrible to feel out of control of your body in any sense. We are conditioned from such a young age that ‘wetting ourselves’ should be a source of extreme embarrassment, and so if you cannot control bladder leakage, it can feel devastating. Stress incontinence can lower self-esteem and cause anxiety and depression.
• Mixed urinary incontinence – Over time, you might develop anxiety about urination and begin to attempt to completely empty your bladder every time you leave the toilet. This can lead to an overactive bladder, and you can develop psychological urge incontinence alongside your physical stress incontinence.
As you can see from the information above, stress incontinence is a condition that affects millions of people, and it has a wide array of causes and symptoms. While some people might find it an occasional inconvenience, for others it can feel like it is ruining their lives.
In addition to using effective incontinence products, those who suffer from stress incontinence have many choices about how they can ease (or completely eradicate) the problem. As with any medical problem, consult with your doctor before starting any treatment plan.
Do you suffer from stress incontinence? Do you want to share any of your own treatment options or experiences? Please comment below, or share this article with your networks.
- Everyday Health. 2011. Can Smoking Cause Embarrassing Bladder Problems?. [ONLINE] Available at: https://www.everydayhealth.com/incontinence/can-smoking-cause-embarrassing-bladder-problems.aspx. [Accessed 3 May 2018].
- Hosie, R, 2017. Stress Incontinence: The Workout Problem No One Is Talking About. The Independent, 24 April 2017. https://www.independent.co.uk/life-style/health-and-families/stress-incontinence-workout-problem-gym-health-exercise-peeing-a7698896.html.
- NHS Choices. 2018. Urinary Incontinence. [ONLINE] Available at: https://www.nhs.uk/conditions/urinary-incontinence/. [Accessed 3 May 2018].
- NHS England. 2018. Complex Gynaecology Services – Recurrent Urinary Incontinence. [ONLINE] Available at: https://www.engage.england.nhs.uk/consultation/specialised-services-policies/user_uploads/recurnt-inctnce-serv-spec.pdf. [Accessed 3 May 2018].5. Nitti, V, 2001. The Prevalence of Urinary Incontinence. Reviews in Urology, [Online]. 3, S2 - S6. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476070/[Accessed 3 May 2018].
- Web MD. 2018. Mixed Incontinence. [ONLINE] Available at: https://www.webmd.com/urinary-incontinence-oab/mixed-incontinence#1. [Accessed 3 May 2018].