Stress Incontinence

Stress Incontinence

The primary symptom of stress incontinence is leakage due to activities that apply pressure to a full bladder. High-impact exercise poses the greatest risk for leaking. But stress incontinence can occur with even minor activities, such as:

• Coughing
• Sneezing
• Laughing
• Running (sometimes even standing can produce leakage)
• Lifting

Leakage stops when the activity stops. If the condition persists, it is more likely to be urge incontinence.

Causes of Stress Incontinence in Women

Stress incontinence occurs because the internal sphincter does not close completely. In both men and women, the aging process causes a general weakening of the sphincter muscles and a decrease in bladder capacity. Causes of stress incontinence, however, may differ between men and women.

In women, stress incontinence is nearly always due to one or both of the following:

• The urethra fails to close and becomes overly movable ( urethral hypermobility).
• The muscles around the bladder neck weaken ( intrinsic sphincteric deficiency or ISD). Some experts believe that this problem is present to some degree in nearly all women with stress incontinence. (ISD can also occur in anyone from an inborn disorder or injury from surgery or radiation.)

Many women are prone to one or both of these problems, which can occur under the following circumstances:

• Having had many children through vaginal deliveries. In such cases, pregnancy and childbirth strain the muscles of the pelvic floor. Prolapsed uterus, in which the uterus protrudes into the vagina, occurs in about half of all women who have given birth. This condition can often cause incontinence.
• Menopause. Estrogen deficiencies after menopause can cause the urethra to thin out so that it may not close properly.

Urethral Hypermobility. In urethral hypermobility the urethra does not close properly and it moves too much (hypermobile). This condition typically occurs when the pelvic floor muscles in women become weak and the following events occur:

• The weakened pelvic floor muscles stretch.
• This allows the bladder to sag downward within the abdomen.
• The sagging bladder pulls on the muscles surrounding the bladder neck (internal sphincter), which are connected to the urethra.