If you leak urine when you cough, sneeze, or laugh, you may have stress urinary incontinence (SUI). Not all urine leakage is SUI. It’s different from urge incontinence (UI), which is a strong, sudden urge to pee, followed by urine leaks.
Some people have both SUI and UI. It’s called mixed incontinence.
What Is Stress Incontinence?
The muscles and tissues of the pelvic floor support your bladder and other organs. SUI can happen when those muscles become weak. If there’s a sudden increase in pressure on your bladder or abdomen, you leak some urine.
With SUI, coughing, laughing, or sneezing can all cause leaks. You may also experience leaks when you push, pull, or lift a heavy object. It can even happen when you have sex.
SUI occurs in women more often than men. According to the Urology Care Foundation, about one in three women suffer from SUI at some point in their lives. It’s more likely to happen as you get older.
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What Are the Symptoms of Stress Incontinence?
If you have SUI, you often leak urine when there’s sudden pressure on your bladder or abdomen. It can happen when you:
- Stand up from a sitting or lying down position.
- Lift heavy objects.
- Have sex.
What Causes Stress Incontinence?
The pelvic floor is a “sling” of muscles that supports the pelvic organs, including the bladder and urethra. SUI happens when the muscles and tissue of the pelvic floor become weak and don’t give proper support.
The pelvic floor can become weak from:
- Jobs that demand heavy and frequent pushing, pulling, or lifting.
- Frequent straining to have a bowel movement.
- Chronic coughing from smoking, asthma, or bronchitis.
- Hormonal changes, as from menopause.
- Side effects of aging, such as loss of muscle mass and reduced nerve function.
Treatment for Stress Incontinence
In most cases, doctors recommend lifestyle changes and physical therapy for SUI.
Lifestyle changes for stress incontinence
Simple changes in your daily habits can improve your SUI. Your doctor may advise you to:
- Maintain a healthy weight. Being overweight puts excess pressure on your pelvic floor, making it weaker.
- Improve your bowel habits. Constipation can put extra pressure on the bladder. To soften stool, eat high fiber fruits and vegetables, drink more water, and cut back on white pasta, rice, and bread. Talk to your doctor about whether you need stool-softening medication.
- Cut back on caffeine and alcohol. Caffeinated drinks and alcohol can irritate the bladder and make SUI worse. If you drink coffee, tea, soda, or alcohol, try to cut back.
- Reduce chronic coughing. Daily coughing puts pressure on the muscles that support your bladder, weakening them. Quit smoking or take steps to manage your asthma or bronchitis. Talk to your primary care doctor about a plan to make your lungs healthier.
Physical therapy for stress incontinence
Your doctor may recommend that you see a physical therapist for SUI. A physical therapist who specializes in SUI can help you:
- Strengthen your core. Your core (abdominal) muscles play an important part in absorbing force created in your trunk by movement (such as sneezing). Strengthening your lower abdominal muscles will help maintain a stable pelvic area.
- Engage your pelvic floor. A physical therapist can teach you proper technique when lifting, pulling, or pushing. You’ll learn how to engage the pelvic floor just before and during any physically demanding task. This can reduce downward stress on the bladder.
- Learn Kegels. These pelvic floor exercises consist of tightening the muscles around your vagina or rectum by squeezing and lifting. You should perform Kegels several times a day, slowly building the number of repetitions and hold time.
(Note: Kegels aren’t right for everyone. Let your doctor know if you’re also having pelvic pain —including pain during intercourse — before starting Kegels. Kegels could make your problem worse, so your doctor should evaluate you first.)
Pelvic floor and core strengthening require consistent exercise to make lasting change. These small muscles can take three to six months or more to become strong enough to see an improvement. A pelvic physical therapist can help teach and motivate you through these workouts.
If you don’t see improvement with lifestyle changes and physical therapy, your doctor may recommend pelvic surgery to treat SUI.
The UPMC Department of Urology offers a wide variety of specialized care for diseases of the male and female urinary tract and the male reproductive organs, including erectile dysfunction, kidney stones, urinary incontinence, prostate cancer, and more. We have a multifaceted team of physicians and researchers working together to provide the best care to both children and adults. Our team is nationally renowned for expertise in highly specialized technologies and minimally invasive surgical techniques. To find a provider near you, visit our website.