Stress incontinence

Stress incontinence is an uncontrollable leakage of urine during physical exertion such as coughing, sneezing, laughing, or performing exercise. Stress incontinence is the most widespread manifestation of urinary incontinence. It is much more common in women than men.

About stress urinary incontinence

Stress incontinence (sometimes known as SUI) happens when there is external pressure or stress on the bladder. This extra pressure causes the bladder to leak urine. How much urine is passed depends on the severity of the incontinence and the level of external pressure applied to the bladder. These external pressures are normally in the form of a strenuous physical activity like lifting a heavy object, performing vigorous exercise or even a simple cough, sneeze or giggle. It is normally caused when the sufferer’s pelvic floor muscles are not strong enough to prevent leakage of urine.

Stress incontinence is the most common form of urinary incontinence, affecting thousands of Singaporeans. It is generally affects older women rather than younger ones. As many as 1 in 5 women over 40 have some degree of stress incontinence.

What causes stress incontinence?

An easy way to imagine stress incontinence is to use an analogy. Picture yourself holding a water filled balloon. The narrow part of the balloon is squeezed shut by your fingers so that the water doesn’t trickle out. But if your fingers get weary, and you compress the balloon just a bit, the water will leak out. The balloon represents your bladder, your fingers represent your pelvic floor muscles and the pressure on the balloon represents some external physical force.

The more medical or technical definition of stress incontinence is that the sphincter muscle surrounding the urethra (the tube connecting your bladder to the outside world) and the pelvic muscles supporting the urethra are so weakened that pressure on the bladder causes these muscles to fail somewhat and allow urine to leak from the bladder. Depending on your level of urinary incontinence, you might not suffer leakage of urine every time you cough, sneeze, laugh, etc. However, if your bladder is full when you do some kind of strenuous physical activity, your chances of suffering from some kind of urinary incontinence are increased.

One of the main reasons for weak pelvic floor muscles in women is pregnancy and giving birth, which tend to put a lot of extra pressure on the pelvic floor muscles. Often these muscles take time to recover. Menopause and ageing can also cause these muscles to lose their elasticity and therefore their effectiveness. Also, certain uterine muscles support the bladder and urethra so a hysterectomy can also cause stress incontinence.

Prostate surgery can cause stress incontinence in men because the prostate supports the urethra and the removal of the prostate can lead to a weakening of the muscles that hold urine in.

Urinary tract infections can also cause stress incontinence. Obesity can put extra pressure on the bladder and urethra and might cause stress incontinence to occur.

Smoking can cause chronic coughing, and coughing contributes greatly to the advent of stress incontinence. Therefore, smoking can indirectly cause the affliction.

Getting diagnosed

Stress incontinence can be diagnosed in a variety of different ways. Generally, you would visit an urologist who would do specialised tests to ascertain if stress incontinence is evident. A bladder stress test, whereby your doctor will ask you to cough forcefully to see if any urine leaks out, could also be done. Your urine could also be analysed to see if any irregularities are found. For difficult cases of stress incontinence, an ultrasound may be done to create a holistic image of your bladder, urethra, pelvic floor muscles etc. Your doctor may also ask you to keep a ‘bladder diary’ to record how often you use the toilet and how much urine there is every time you go. This diary and your medical history may help your doctor diagnose your problem, or at the very least help your doctor send you for the right diagnostic tests.

Stress incontinence treatment

If you suffer from stress incontinence, you may feel self-conscious, keep to yourself or curtail the professional and social aspects of your life, in particular exercise and other activities. But with treatment for your stress incontinence, you would be able to lead a relatively trouble-free life. Your treatment will depend on the severity of your stress incontinence and its root cause.

Here are the most commonly used stress incontinence management techniques, exercises and tips:

  • Pelvic floor exercises / kegel exercises: These exercises strengthen and improve the performance of your pelvic floor muscles and decrease the chance that stress incontinence will strike. 
  • Behavioural changes: The wide variety of behavioural modifications that can be used to combat stress incontinence include:
    • Drinking fewer liquids and in particular coffee and alcohol
    • Going to the bathroom more often so that your bladder is seldom full
    • Avoiding activities that might lead to stress incontinence. For example, jumping or strenuous running
    • Giving up smoking to avoid getting a chronic cough
    • Losing weight if you are overweight
    • Avoiding drinks and food that might aggravate your bladder like curries and fizzy soft drinks
  • Incontinence medication: Medication can sometimes be used to treat stress incontinence. It is usually more effective with people who don’t suffer from severe cases of the ailment. These medications usually work by helping your bladder leak less urine
  • Incontinence surgery: This is normally the last resort and should only be performed if all other treatment options have been exhausted.

Suffering from stress incontinence is not a normal part of aging or childbirth and definitely not something that you need to learn to live with. Solutions are available to help manage stress incontinence by decreasing its impact on your everyday activities. You may need to speak to your doctor or get a referral to a specialist so the two of you can map out a plan to manage your stress incontinence.