Stress incontinence is leakage of urine during physical activities. For example, you may leak urine when you exercise, cough, sneeze, laugh, lift, or have sex. It is a common problem for women.
The pelvic floor muscles normally fit snugly around the neck of the bladder. They form a ring of muscle that keeps urine from escaping through the urethra. The urethra is the tube that carries urine out of the bladder. The pelvic floor muscles can be stretched or torn during childbearing. Also, after menopause the lack of estrogen causes a thinning of tissues. This can cause loss of muscle tone. Sudden pressure on the bladder (for example, from coughing or sneezing) can overcome the weakened muscles and cause some urine to escape.
A less common cause is pelvic surgery, which can either weaken pelvic muscles or damage pelvic nerves.
Symptoms include leakage of urine during lifting or other physical activity, laughing, coughing, or sneezing.
Your healthcare provider will ask about your symptoms and medical history and examine you. Samples of your blood and urine will be tested. You may be referred to a specialist, such as a urologist or gynecologist, for further investigation and treatment. (A urologist is a healthcare provider 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 healthcare and especially in disorders of the reproductive tract of women.)
Weak pelvic floor muscles can often be strengthened by Kegel exercises. You can feel the muscles that need to be exercised by squeezing the muscles in your genital area. You might find that it helps to pretend you are contracting the pelvic muscles to stop a flow of urine or stop from passing gas. To do the exercises:
You can do Kegel exercises anywhere: while sitting at a desk, waiting for a bus, washing dishes, driving a car, waiting in line, or watching television. No one will know you are doing them.
You may see a change for the better after doing the Kegels for just a few weeks. However, you may not notice a lot of improvement until after 3 to 6 months of daily exercises. You should keep doing Kegels every day to keep the pelvic muscles strong.
You may want to ask your healthcare provider about cones that can be used to help strengthen the pelvic floor muscles. The cones come in different sizes. You may start with a large cone. You put it into your vagina and try to hold it in place for 15 minutes a couple of times a day by contracting your pelvic or vaginal muscles. When this is easy for you to do, you may then try keeping a smaller cone in place. Your healthcare provider can order the cones from a surgical supply company.
It may be hard for you to find the correct muscles to squeeze for the Kegel exercises. If you are having trouble doing Kegels, you may be able to get help from biofeedback or a physical therapist with expertise in pelvic floor exercises.
Some medicines can help tighten the ring of muscles that control release of urine.
When symptoms are severe and attempts to strengthen these tissues with exercise or other medical treatments have not succeeded, surgery may be done to provide support to the bladder and the pelvic muscles.
