A lack of bladder control is known as urinary incontinence. It is an embarrassment for as many as one in three Americans age 60 or older and is twice as common in women as men. Stress incontinence is the most common kind of urinary incontinence in women. It is the term used for leakage of urine during exercise, coughing, sneezing, laughing, or lifting.

What causes stress incontinence?

The pelvic floor muscles normally fit snugly around the neck of the bladder. They form a ring of muscle that prevents urine from escaping through the urethra, which is the tube that carries urine from the bladder. However, the pelvic floor muscles can be stretched or torn during childbearing. There may also be further loss of muscle tone after menopause due to a thinning of tissues caused by a lack of estrogen. Sudden pressure on the bladder (for example, from coughing or sneezing) can overcome the weakened muscles and cause a little urine to escape. Diabetes, obesity, and urinary tract infections also contribute to stress incontinence.

What are the symptoms?

Symptoms include leakage of urine during exercise, laughing, coughing, sneezing, or lifting.

How is it diagnosed?

Your health care provider will take a careful history and examine you to see if the incontinence is caused by an underlying condition that can be corrected. Your blood and urine will be checked for infection or other abnormalities. You may be referred to a urologist or gynecologist for further investigation and treatment. (A urologist is a doctor who specializes in disorders of the urinary tract in both men and women and in the reproductive tract of men. A gynecologist specializes in women's health care and especially in disorders of the reproductive tract of women.)

How is it treated?

Weak pelvic muscles can often be strengthened by Kegel exercises. The next time you use the bathroom, try to stop the flow of urine. The muscles used to stop the flow are the same muscles that need to be strengthened. One of the ways to do Kegel exercises is to tighten these muscles for a count of four and then relax them. Repeat this tightening 10 to 20 times. (You may want to check with your health care provider to make sure you are doing the exercise correctly.) If you do the Kegel exercise several times faithfully each day, you should see improvement in about 2 months. Vaginal muscle tone will improve at the same time, which may make you more sexually responsive. Some medications can help tighten the ring of muscles that control release of urine. Estrogen therapy may be prescribed to increase circulation, tone, and urethral muscle response in postmenopausal women. The pelvic muscles may also be tightened by surgery. Your health care provider may prescribe a pessary, which is a device similar to the outer ring of a diaphragm. A pessary is inserted into the vagina. It gives support to the pelvic structures and may help to prevent stress incontinence. Your health care provider may advise using a pessary to support lax pelvic muscles if this is contributing to the incontinence. If medical or surgical treatment does not help or is not available, you can buy incontinence pads at the grocery or drug store. They are available in all sizes and degrees of absorbency, but they are expensive.

How can I take care of myself?

Consult your health care provider if you begin to have urinary incontinence. Follow his or her advice for correcting or managing your incontinence.
Practice bladder control. Do Kegel exercises regularly.
Use incontinence pads if you need to. Be sure to change them regularly.
Keep your groin area as clean and as dry as possible.

Robert B. McWilliams, MD

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Robert B. McWilliams, MD Reproductive Endocrinology and Gynecology

Stress Incontinence in Women

Robert B. McWilliams, MD
Reproductive Endocrinology
and Gynecology