Stress urinary incontinence

Stress urinary incontinence is a very common, chronic (long-term) bladder problem which mainly affects women but can also affect men. Stress urinary incontinence can occur at any age although the risk increases as you get older.

One in three women over 40 has stress urinary incontinence. Stress urinary incontinence in women is often the result of weak or damaged pelvic floor muscles. These muscles control the flow of urine and can weaken with age or be damaged by pregnancy or childbirth.

Stress urinary incontinence in men may be the result of prostate cancer treatment or damage to the pelvic nerve.

Stress urinary incontinence can usually be successfully managed by lifestyle changes, pelvic floor muscle exercises, bladder training or surgery.

The main stress urinary incontinence symptom is accidentally leaking urine when you:

• Sneeze, cough or laugh
• Exercise
• Lift something heavy
• Stand up
• Have sex

Your GP will ask you about your stress urinary incontinence symptoms. If possible, for a week, write down episodes of urine leakage, your fluid intake and how often you urinate.

Your GP may test for urinary tract infections (UTI). They may also examine your pelvic area and, in men, your prostate gland.

To help with diagnosis your GP may refer you for:

• An ultrasound scan – to check your bladder is emptying properly
• Cystoscopy – to check for bladder problems and examine your urinary system
• Urodynamic tests – to measure urine flow and bladder capacity
• An X-ray – a special dye highlights the flow of urine through your bladder and kidneys

For further assessment, your GP may refer you to a urologist, a consultant specialising in the urinary system or to a continence clinic or specialist continence nurse.

Stress urinary incontinence causes include:

• Childbirth – the more babies you have, the higher your risk of stress urinary incontinence
• Pregnancy or obesity – carrying additional weight on your abdomen increases pressure on your bladder
• Age – pelvic floor muscles can weaken as you age
• Surgical removal of your womb (hysterectomy) or prostate gland (in men)
• Damage or injury to your urethra
• A prolapse – when the bladder pushes into your vaginal walls

To treat stress urinary incontinence, your GP or consultant may suggest:

• Pelvic floor exercises – to strengthen the muscles controlling the flow of urine
• Losing weight – to reduce pressure on your bladder
• Reducing your fluid intake and, in particular, caffeine and alcohol
• Stopping smoking – to reduce coughing
• Inserting a special device in your urethra or vagina – to prevent urine leakage
• Wearing disposable pants and pads - to absorb leaking urine

If there’s no improvement in your urinary incontinence symptoms, your doctor may recommend surgery. Surgery may be required to:

• Repair a prolapse
• Support your bladder
• Strengthen pelvic floor muscles
• Increase bladder size