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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
If you worry that a burst of laughter, cough, or powerful sneeze will cause an embarrassing bladder leak, you may have a common problem called stress urinary incontinence.
Millions of people have stress urinary incontinence. And when we talk about stress, we don’t mean emotional. Rather, it’s the physical stress or pressure put on the bladder that can make you pee when you sneeze.
This type of incontinence can be more than just an annoyance––it severely impacts some people’s lives and causes them to avoid certain activities. Fortunately, there are steps you can take to manage leaks and improve your quality of life.
What is stress urinary incontinence?
Stress urinary incontinence (SUI) is the sudden, involuntary release of urine due to increased abdominal pressure. Beyond sneezing, coughing, and laughing, SUI can happen while exercising, straining, or performing any activities that put pressure on the gut area.
The amount of pee that comes out during a sneeze can be a few drops or enough to soak a pad. SUI often overlaps with other conditions that cause leakage, like urinary incontinence from an overactive bladder.
What causes stress incontinence?
SUI occurs when the urethra (the tube that carries urine) can’t keep urine in the bladder. This can be due to stretched or injured pelvic muscles, nerve damage, or changes in the sphincter that tightens the opening of the urethra (Aoki, 2017).
A variety of things can change affect the anatomy of your pelvis and make SUI more likely including (Rajavouri, 2022; Baessler, 2018):
- Pelvic floor trauma during childbirth
- Pelvic organ prolapse
- Pelvic surgery (can weaken muscles or affect nerves)
- Nerve damage
- Prostate surgery, including removal of the prostate gland
- Constipation (excessive stool in the colon puts pressure on the bladder)
- Heavy lifting
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Stress urinary incontinence: women vs. men
Women are more likely to have SUI than men. More than 15% of adult women experience it. About 77% of those call it bothersome while nearly 29% say it’s moderate to severe.
SUI increases with age, particularly during menopause. One study found that roughly 41% of women over age 40 develop urinary incontinence and up to 77% of elderly women in nursing homes live with some form of it (Lugo, 2021).
Men also experience SUI, but not as often. Having the prostate gland removed increases the likelihood. Damage or changes to the nerves, sphincter, or pelvic floor can also lead to SUI in men (Trost, 2012).
Types of urinary incontinence
SUI often overlaps with other types of urinary incontinence including:
- Urge incontinence: This is when you have a strong urge or need to urinate. Leaks happen when you can’t make it to the bathroom in time. Urge incontinence is often linked to an overactive bladder and is most common in older people. It can also be a sign of a urinary tract infection (Chang, 2020).
- Overflow incontinence: This happens when your bladder doesn’t fully empty. It ends up carrying too much urine, which can lead to leaks. Overflow incontinence is most common in men and can be caused by kidney stones, tumors, diabetes, and some medications (Lugo, 2021).
- Transient incontinence: Medications and infections can cause this type. Transient incontinence is temporary and goes away after a medication is stopped or an infection has resolved (Aoki, 2017).
Diagnosing stress incontinence
A diagnosis starts with talking to a healthcare provider. They can help figure out if you have SUI or a combination of other types of incontinence. It’s important to sort these out because there are different treatments depending on your circumstance.
During an evaluation, you’ll be asked about your past medical history including if you’ve had surgery, been pregnant, or taken medication. All of these can affect how well you hold urine. You may be referred to professionals who specialize in urinary tract problems like a urogynecologist or urologist.
The physical exam may involve a pelvic or rectal exam, along with urine, blood, and bladder function tests. For women, the exam usually involves a check for pelvic organ prolapse. This happens when weak pelvic muscles can’t hold up organs and they start to drop down. It also puts pressure on the bladder. You may be asked to cough with a full bladder and track how much urine comes out using pads (Lugo, 2021).
A tool called a voiding diary is often used to diagnose and manage SUI. To create a voiding diary, keep track of how much you drink and urinate. Note the time you drink, when a leak happens, and what triggered it. This can help your healthcare provider assess the severity of the problem and find the appropriate treatment for it (Aoki, 2017).
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How to treat stress incontinence
Sudden loss of urine can be described in varying degrees, such as leaking, dripping, or flooding. How much incontinence affects you can help guide your treatment decisions.
Some recommended tactics include pelvic floor muscle exercises (Kegels), along with lifestyle and behavioral changes. If these aren’t enough, medical approaches can be used to help prevent urine leakage (Lugo, 2021; Aoki, 2017).
Which therapy works best for you depends on what’s causing your incontinence and the severity of it. The following are typically incorporated into an overall SUI treatment plan.
Knowing how much you drink and how quickly you need a restroom afterward can help prevent leaks. This may take some tracking.
Plan out when you have drinks and restroom breaks so any activities you’re participating in (like exercise or social events) are done on an empty bladder.
Pelvic muscle exercises
The stronger your pelvic muscles, the better they are at holding in urine and preventing leaks. Both men and women can practice strengthening their muscles with Kegel exercises.
If you’re not sure where your pelvic floor muscles are, stop urinating midstream. The muscles that control urine flow are the ones to focus on during Kegels. During these pelvic floor exercises, you’ll practice contracting these muscles. Here’s a typical Kegel routine (Huang, 2021; Lugo, 2021):
- Tighten muscles for five seconds. Release for five seconds and repeat.
- Work up to 10 seconds intervals.
- Breathe normally during the exercises and try not to tighten other muscles.
- Attempt 10 Kegels for 10 seconds each at least three times a day.
Some medical experts suggest that three months of pelvic floor exercises can make a noticeable difference. There are additional techniques designed to boost the effects of pelvic muscle therapy including weighted vaginal cones and biofeedback.
Electromyographic biofeedback uses a vaginal probe to measure muscle activity in your pelvic area. Studies are mixed on how well add-on biofeedback training methods work to enhance pelvic floor muscle exercises (Hagen, 2020; Wu, 2021).
This is usually done to help manage urge urinary incontinence. It involves setting regular restroom break intervals and then increasing those intervals over time. This gets your bladder accustomed to waiting for longer periods before needing to release (Lugo, 2021).
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Avoiding bladder irritants
Caffeinated drinks (like coffee, tea, and soda) and alcohol increase urine production. If you have bladder problems, spicy foods, citrus, tomatoes, chocolate, and tobacco have been known to irritate the bladder.
If you think your diet is affecting your bladder, talk to a healthcare provider. Some suggest eliminating specific food or drinks and then adding them back in slowly to figure out the source (Lugo, 2021).
Other lifestyle approaches to reduce SUI include:
- Maintain a healthy weight
- Avoid constipation by eating fiber-packed foods and drinking plenty of water
- Quit smoking
- Get regular exercise
Medication and procedures
If lifestyle changes and pelvic floor muscle exercises aren’t enough, there are still some more treatment options. These are tailored based on the type of incontinence you have or whether physical changes are causing the problem (Lugo, 2021; MedlinePlus, 2016).
- Medication: Drugs used to treat bladder control problems work in different ways. Some relax bladder muscles to prevent spasms. Others help sphincter muscles contract. Estrogen may restore vaginal tissue quality. For men, some medications reduce prostate size and improve urine flow.
- Vaginal pessaries: In women, a small tampon-like device can be placed in the vagina that pushes against the urethra to stop leaks.
- Bulking agents: Adding bulk around the urethra using injectable collagen or similar materials can limit accidental leaks (Mamut, 2017).
- Surgery: A sling procedure or mesh is surgically placed in the body to support the bladder in a way that inhibits leaks (Bole, 2021).
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When to see a healthcare provider
If incontinence is affecting your quality of life, talk with a healthcare professional. It’s common for many people to keep incontinence a secret, even from their own doctor. One study showed only about 25% of women with incontinence sought treatment (Minassian, 2012).
However, healthcare providers are used to talking about these topics. They view it as a medical condition and will want to work with you to find medical solutions. Treatments may vary depending on each case, but there is usually a way to prevent leaks while staying active.
- Aoki, Y., Brown, H. W., Brubaker, L., et al. (2017). Urinary incontinence in women. Nature Reviews Disease Primers, 3(1). doi:10.1038/nrdp.2017.42. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878864/
- Baessler, K., Christmann-Schmid, C., Maher, C., et al. (2018). Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. Cochrane Database of Systematic Reviews, 2018(8). doi:10.1002/14651858.cd013108. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513383/
- Bole, R., Hebert, K. J., Gottlich, H. C., et al. (2021). Narrative review of male urethral sling for post-prostatectomy stress incontinence: Sling Type, patient selection, and clinical applications. Translational Andrology and Urology, 10(6), 2682–2694. doi:10.21037/tau-20-1459. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261433/
- Chang, Y. H., Hsiao, P. J., Chi-Ping, H., et al. (2020). A Comparative Observational Study to Evaluate the Efficacy of Mid-Urethral Sling with Botulinum Toxin A Injection in Urinary Incontinence Patients. Toxins, 12(6), 365. doi:10.3390/toxins12060365. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354459/
- Hagen, S., Elders, A., Stratton, S., et al. (2020). Effectiveness of pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: Multicentre randomised controlled trial. BMJ. doi:10.1136/bmj.m3719. Retrieved from https://www.bmj.com/content/371/bmj.m3719
- Huang, Y. C. (2021). Kegel exercises. StatPearls. Retrieved March 2, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK555898/
- Lugo, T. (2021). Stress incontinence. StatPearls. Retrieved March 2, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK539769/
- Mamut, A. & Carlson, K. V. (2017). Periurethral bulking agents for female stress urinary incontinence in Canada. Canadian Urological Association Journal, 11(6S2), 152. doi:10.5489/cuaj.4612. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461150/
- Minassian, V. A., Yan, X., Lichtenfeld, M. J., et al. (2012). The Iceberg of Health Care Utilization in women with urinary incontinence. International Urogynecology Journal, 23(8), 1087–1093. doi:10.1007/s00192-012-1743-x. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905313/
- Rajavuori, A., Repo, J. P., Häkkinen, A., et al. (2022). Maternal risk factors of urinary incontinence during pregnancy and postpartum: A prospective cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 13, 100138. doi:10.1016/j.eurox.2021.100138. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8605044/
- Trost, L. & Elliott, D. S. (2012). Male stress urinary incontinence: A review of surgical treatment options and outcomes. Advances in Urology, 1–13. doi:10.1155/2012/287489. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356867/
- MedlinePlus. (2022). Urinary incontinence | stress incontinence | UI. Retrieved from https://medlineplus.gov/urinaryincontinence.html#:~:text=Stress%20incontinence%20happens%20when%20stress,out%20of%20its%20normal%20position
- Wu, X., Zheng, X., Yi, X., et al. (2021). Electromyographic biofeedback for stress urinary incontinence or pelvic floor dysfunction in women: A systematic review and meta-analysis. Advances in Therapy, 38(8), 4163–4177. doi:10.1007/s12325-021-01831-6. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8342347/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.