You have had more than one pregnancy and vaginal delivery.
You have pelvic prolapse. This is when your bladder, urethra, or rectum slide into the vagina. Delivering a baby can cause nerve or tissue damage in the pelvic area. This can lead to pelvic prolapse months or years after delivery.
The main symptom of stress incontinence is leaking urine when you:
Are physically active
Have sexual intercourse
Exams and Tests
Your health care provider will perform a physical exam. This will include:
Genital exam in men
Pelvic exam in women
Tests may include:
Cystoscopy to look inside the bladder
Pad weight test. You exercise while wearing a sanitary pad. Then the pad is weighed to find out how much urine you lost.
Voiding diary. You track your urinary habits, leakage and fluid intake.
Urinary stress test (you stand with a full bladder and then cough)
Urodynamic studies to measure pressure and urine flow
X-rays with contrast dye to look at your kidneys and bladder
Treatment depends on how your symptoms affect your life.
There are four types of treatment for stress incontinence:
Pelvic floor muscle training
Making these changes may help:
Drink less fluid (if you drink more than normal amounts of fluid).
DO NOT hold it. Urinate when you first feel the urge. This may help reduce the amount of urine that leaks.
Avoid jumping or running.
Take fiber to avoid constipation, which can make urinary incontinence worse.
Quit smoking. This can reduce coughing and bladder irritation. Smoking also increases your risk for bladder cancer.
Avoid alcohol and caffeinated drinks such as coffee. They can cause the urge to urinate.
Lose excess weight.
Avoid foods and drinks that may irritate your bladder. These include spicy foods, carbonated drinks, and citrus.
If you have diabetes, keep your blood sugar under good control.
PELVIC FLOOR MUSCLE TRAINING
There are different ways to strengthen the muscles in your pelvic floor.
Biofeedback. This method can help you learn to identify and control your pelvic floor muscles.
Kegel exercises. These exercises can help keep the muscle around your urethra strong and working well. This may help keep you from leaking urine.
Vaginal cones. You place the cone into the vagina. Then you try to squeeze your pelvic floor muscles to hold the cone in place. You can wear the cone for up to 15 minutes at a time, two times a day. You may notice improvement in your symptoms in 4 to 6 weeks.
Pelvic floor physical therapy. Physical therapists specially trained in the area can fully evaluate the problem and help with exercises and therapies.
Medicines tend to work better if you have mild to moderate incontinence. Your provider may prescribe one or more medicine. (These medicines do not always work with stress urinary incontinence.)
Anticholinergic medicines help relax the muscles of the bladder. They include oxybutynin (Oxytrol, Ditropan), tolterodine (Detrol), darifenacin (Enablex), trospium (Sanctura), and solifenacin (Vesicare).
If you have trouble completely emptying your bladder, you may need to use a catheter. This is a very small tube you place in your urethra to drain urine from your bladder.
Getting better takes time so try to be patient. Symptoms most often get better with nonsurgical treatments. However, they will not cure stress incontinence. Surgery can cure some people with stress incontinence.
Treatment does not work as well if you have:
Conditions that prevent healing or make surgery more difficult
Other genital or urinary problems
Past surgery that did not work
Physical complications are rare and most often mild. They can include:
Wearing away of materials placed during surgery, such as a sling or artificial sphincter
Jennifer Sobol, DO, urologist at the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.