When a person leaks urine during a cough, sneeze, laugh, or other physical activity, it’s known as stress incontinence. It’s the most common type of urinary incontinence in younger women, but can occur across a woman’s lifespan and tends to get worse as people get older. It is far less common in men, but can happen after prostate surgery.

Stress incontinence occurs when the muscles that normally prevent urine leakage become weakened for various reasons, including aging, childbirth, or pelvic surgery. When a person coughs or experiences another kind of abdominal pressure, those muscles may loosen their hold, leading to urine leakage.

Stress incontinence is more common in women than in men due to unique health events, such as pregnancy, childbirth, or menopause, which can affect the muscles surrounding the urinary tract. Still, men can be affected by stress incontinence, particularly those who have had their prostate surgically removed.

The condition is generally more common among older adults. However, stress incontinence is not a normal part of aging. A number of treatments, including muscle-strengthening exercises and surgery, are available to help relieve stress incontinence. These treatments can reduce the incidence of leaks and improve a person’s quality of life.

Stress incontinence is the term used to describe a person’s inability to hold in their urine during moments of sudden abdominal pressure. This can occur during activities ranging from sneezing or laughing to running or jumping rope.

In an individual without the condition, properly functioning pelvic floor muscles (which surround the bladder and the urethra) and the sphincter muscle (located where the bladder meets the urethra) work together to prevent urine leakage. (The urethra is a thin tube that carries urine from the bladder out of the body.)

When a person coughs or jumps, their pelvic floor muscles and sphincter maintain their muscle tone, keeping the urine in the bladder until they are ready to use the bathroom. But when a person has a weakened or damaged sphincter or pelvic floor muscles, those muscles aren’t able to keep the urethra closed during bursts of increased pressure in the abdomen, leading to urine leakage.

People with stress incontinence may have weakened pelvic floor muscles or a damaged sphincter due to the following:

• Pregnancy
• Childbirth
• Aging
• Prostate surgery (males)
• Chronic constipation
• A history of heavy lifting

Additionally, a condition known as “pelvic organ prolapse,” when the bladder or urethra slips downward in the vagina causing a bulge sensation, may be associated with higher rates of incontinence.

When a person experiences stress incontinence, they leak urine when they cough, sneeze, laugh, jump, lift, or perform other physical movement that causes a sudden jolt of abdominal pressure.

People are more likely to experience stress incontinence if they:

• Are female
• Are male and have had their prostate surgically removed
• Are older adults
• Are pregnant
• Smoke
• Have a chronic cough
• Have chronic constipation
• Lift heavy objects for work
• Follow an intense exercise regimen (female athletes)

You may be diagnosed with stress incontinence after sharing your medical history with a doctor, getting a physical exam, and undergoing diagnostic testing.

When you share your medical history, let your doctor know what sensations you experience when you leak urine, what activities cause it, whether it stops after you’ve finished those activities, and how long the problem has existed.

If you noticed that the problem arose after childbirth, prostate surgery, or another key health event, share that information with your doctor. It’s also helpful to mention your smoking history, whether you have asthma or another condition that causes chronic cough, and whether you lift heavy objects at work or at home.

Some doctors may ask you to keep a bladder diary for a few days to note how much you drink, how often (and how much) you urinate, what activities lead to leakage, and how often it occurs.

To evaluate stress incontinence in women, doctors will perform a pelvic exam to check for pelvic muscle strength and pelvic organ prolapse.

The doctor may advise you to come to the appointment with a full bladder, then ask you to cough, jump, or otherwise exert pressure on the abdomen that would cause urine leakage.

Doctors may also offer the following diagnostic tests:

• Bladder scan, to see how much urine remains in the bladder after a patient urinates
• A urine test, to check for urinary tract infection
• Urodynamics, a test that evaluates bladder and urethral pressures during bladder filling, any bladder leaks, and urinating
• Cystoscopy, during which a thin tube with a camera attached to its end is threaded up the urethra into the bladder to check for structural abnormalities; this test is only used occasionally.

A number of treatments are available to manage stress incontinence, ranging from lifestyle remedies to surgical intervention.

Non-surgical options include the following:

• Lifestyle modifications:
  • Losing weight, for people who are overweight or obese
  • Quitting smoking
    
  • Taking fiber supplements to improve bowel regularity, if constipation is a concern
    
  • Drinking less liquid, to avoid filling the bladder too quickly
    
  • Following a timed voiding schedule
    
  • Practicing pelvic floor muscles exercises (some called “Kegel” exercises), which strengthen the pelvic floor, either at home or with a specialized physical therapist. This involves squeezing and holding the muscles that would stop the flow of urine several times per day (although these exercises should not be performed while urinating).
    
• Devices:
  • For women: Using a pessary, a small device that can be placed in the vagina to exert pressure on the urethra and help it to remain more tightly closed, thereby preventing leaks
  • For men: Wearing an incontinence clamp on the penis for short periods of time to exert pressure on the urethra, thus preventing leaks
    

Surgical options include:

• Sling surgery, which uses surgical mesh or tissue from the patient’s body to support the urethra or bladder, thus preventing leakage.
• Bulking agents which are placed near the bladder. They help bulk up the tissue surrounding the urethra, making it more difficult for urine to leak. Repeat injections may be needed.

Treatments can help people with stress incontinence reduce or eliminate urine leakage so that they can do all of the activities they enjoy and improve their quality of life.

In cases where non-surgical options are ineffective, patients may require surgery. About 80% to 90% of women who undergo surgery for stress incontinence notice a significant improvement.

Yale is a regional center for expertise in the management of urinary incontinence. With fellowship-trained specialists from both urology and gynecology backgrounds, our physicians work together to provide the most comprehensive care, with a focus on well-studied, evidence-based treatments and a patient-centered approach.

When surgery is indicated, we can use minimally invasive approaches that have a shorter recovery period so that people can get back to their lives. In addition, there are ongoing research studies for ways to improve incontinence treatment, including access to care issues, patient education, and better post-operative recovery.

“Each woman has a different complex of symptoms, lifestyle, and activities that are affected by her incontinence,” says Yale Medicine urogynecologist Leslie Rickey, MD, MPH. “Patients also have different treatment goals,” Dr. Rickey explains. “Many pelvic floor conditions co-occur, so I think it is critical to go to a physician who is going to query all of the pelvic floor symptoms a woman might have, including bladder, uterus, vaginal, and bowel issues. We take a very multi-disciplinary approach to patient care.”