What Are the Causes and Types of Stress Incontinence?

The cause of stress incontinence is when the bladder and/or urethra gets weakened or damaged. The types of stress incontinence include functional incontinence, overactive bladder, mixed incontinence, overflow incontinence, and reflex incontinence.

Stress urinary incontinence (SUI) is when urine involuntarily leaks during moments of physical activity that increases the pressure on the abdomen, such as coughing, exercise, laughing, or sneezing.

While SUI can happen to anyone at any age, it’s most common among older women. About a third of women over 60 sometimes leak urine, while half of women over 65 find that they do. Men are more likely to have an overactive bladder than SUI, and for those who do have SUI, it is likely due to prostate cancer surgery or pelvic nerve damage.

The most common symptom of SUI is when urine leaks out during an activity that increases pressure on the abdomen. It can be either a small leak of a few drops or up to full emptying of the bladder.

A mild case of SUI will usually result in leakage only during strenuous physical activity, such as exercise or intense yard work. Moderate to more severe cases of SUI will cause leakage more often and with less strenuous activities, such as standing up from a chair or bending over to pick something up.

Stress incontinence is only one kind of incontinence a person can experience. Other types include:

Functional incontinence

If your urinary tract is functioning properly but another illness or disability prevents you from being able to properly relieve your bladder, this is known as functional incontinence. Medications, dementia, or mental illness, for example, can decrease your ability to seek out and find a toilet. Arthritis can also make it difficult to get to the bathroom in time.

Overactive bladder

This type of incontinence is when you have a strong urge to urinate even when your bladder isn't full. This is also known as urge incontinence. This condition occurs in both genders and involves an overwhelming urge to immediately relieve your bladder, but are unable to hold it.

Mixed incontinence

A combination of symptoms of overactive bladder and stress incontinence is known as mixed incontinence. It is typical for women with incontinence to have both stress and urge symptoms. Mixed incontinence also occurs in men who’ve had an enlarged prostate removed. Frail, older people of either gender are also more likely to have mixed incontinence.

Overflow incontinence

If you’re not able to completely empty your bladder, you might experience urine leakage. This incontinence can occur when something blocks urine from flowing normally out of the bladder, like an enlarged prostate. Eventually, the bladder fills up completely and opens the urethra, allowing urine to leak out. The bladder might also spasm at random times, which also can cause leakage.

Reflex incontinence

Reflex incontinence happens when the bladder muscle contracts without warning. This typically happens as a result of damage to the nerves responsible for warning the brain that the bladder is getting full. People who have serious neurological disabilities from disease, surgery, or injury can expect to experience reflex incontinence.

The bladder and urethra are supported by the pelvic floor in the body. SUI can happen if this area gets weakened or damaged. Pregnancy and childbirth, for example, can cause this, as can chronic coughing, nerve injuries to the lower back, or pelvic surgery.

There is often no identifiable cause for an overactive bladder. People are more likely to develop the problem, however, as their bodies get older. Postmenopausal women, in particular, are prone to develop this condition.

You should speak to your doctor if you are experiencing any form of incontinence like SUI. They will review your medical history and perform a physical exam to try and identify the cause of your incontinence. If needed, they will refer you to a specialist like a urologist or a gynecologist. These are doctors who have more experience with pelvic floor conditions like urinary incontinence.

Currently, there aren’t any drugs approved in the United States to treat SUI. If you have OAB or mixed incontinence, your doctor may prescribe OAB medicines or treatments. These may help OAB, but will not treat SUI.

Nonsurgical treatment options

Examples of nonsurgical treatment options for SUI include:

• Behavioral change: This includes avoiding activities that trigger episodes of leaking
• Kegel exercises: A type of exercise to strengthen the pelvic floor by contracting and relaxing the muscles that surround the opening of the urethra, vagina, and rectum
• Pessary: For women, this is a removable device that is placed against the vaginal wall and urethra to support the bladder neck. This has been shown to help reduce SUI by repositioning the urethra
• Transurethral bulking agents: Collagen injections around the urethra that make the space around the urethra thicker, which helps to control urine leakage

Surgical treatment options

There are surgical procedures done through the abdomen or vagina that can help decrease or prevent urine leakage. The urethra or bladder neck is supported with either stitches alone or with tissue from another part of the body or a donor. Another option is to surgically install a mesh sling, permanently implanted to support the urethra or bladder neck. This is commonly referred to as a "sling procedure."