Stress Incontinence
Stress Incontinence in Women
Stress incontinence is urine leakage during activities that increase pressure inside your abdomen, such as coughing, sneezing, laughing, lifting, running or jumping. It commonly relates to changes in pelvic floor support, muscle function or coordination.
Stress incontinence is common during or after pregnancy, following childbirth and around menopause. It can also affect younger active women. Although leakage can be frustrating or embarrassing, conservative management including guided pelvic floor exercises may help improve bladder control.
What Is Stress Incontinence?
Stress urinary incontinence occurs when urine leaks during an increase in abdominal pressure. This commonly happens with coughing, sneezing, laughing, lifting, running, jumping or other physical activity.
Your pelvic floor muscles and the tissues around the bladder and urethra help maintain continence. When their support, strength or timing is insufficient for the pressure generated by an activity, urine may leak.
What Does Stress Incontinence Feel Like?
The main symptom is involuntary urine leakage associated with physical effort or an increase in abdominal pressure. You may notice leakage when:
- coughing, sneezing or laughing
- running, jumping or playing sport
- lifting weights or heavier objects
- performing higher-impact gym exercises
- moving quickly or completing physically demanding activities
The amount and frequency of leakage vary. Some women experience only occasional small leaks, while others find the problem affects exercise, work, social activities or confidence.
Stress Incontinence vs Urge Incontinence
Stress incontinence is different from urgency-related leakage. Stress leakage occurs primarily with physical pressure or effort. Urge incontinence is more strongly associated with a sudden, difficult-to-delay need to pass urine.
Some women experience both. This is known as mixed urinary incontinence. If urgency or frequent urination is a significant part of your symptoms, read more about overactive bladder and urge incontinence.
What Causes Stress Incontinence?
Stress incontinence occurs when the continence system cannot adequately respond to an increase in pressure around the bladder. Several factors may contribute rather than there being one single cause.
Common contributing factors include:
- pregnancy and childbirth
- changes in pelvic floor muscle strength or endurance
- reduced pelvic floor muscle timing or coordination
- menopause and associated tissue changes
- constipation and repeated straining
- persistent coughing
- repeated heavy lifting
- high-impact exercise
- previous pelvic surgery
Identifying the factors relevant to you helps guide an individual treatment program.
Who Is More Likely to Experience Stress Incontinence?
Stress incontinence is common during pregnancy, after childbirth and during midlife. However, it is not limited to these stages of life. Younger women and athletes can also experience leakage, particularly during running, jumping, heavy lifting or high-impact sport.
Because bladder symptoms can have different causes, persistent or troublesome leakage is worth discussing with an appropriately trained health professional.
How Is Stress Incontinence Assessed?
A physiotherapist with an interest in women’s or pelvic health will usually begin by asking about your bladder symptoms, medical history, pregnancy or childbirth history where relevant, bowel habits, exercise and the activities that trigger leakage.
Your assessment may consider:
Pelvic floor function
Strength, endurance, relaxation, awareness and coordination may be assessed where appropriate.
Timing
Your physiotherapist may assess how your pelvic floor responds during coughing, lifting or other activities that trigger leakage.
Breathing and pressure
Breathing, abdominal pressure and movement strategies may influence how load is managed through the pelvic floor.
Daily activities
Exercise, sport, work, lifting and other activities can help identify when and why leakage occurs.
Bladder and bowel habits
Urinary frequency, urgency, fluid intake, constipation and straining can provide useful clinical information.
Your goals
Treatment should reflect what you want to return to, from comfortable daily activity to gym training, running or sport.
Your physiotherapist will explain appropriate assessment options and obtain your consent. Not everyone requires the same physical assessment.
In some circumstances, your GP or specialist may recommend further investigation. Urodynamic testing is generally reserved for selected or more complex presentations rather than being required for everyone with stress incontinence.
How Can Physiotherapy Help Stress Incontinence?
Pelvic floor muscle training is an established conservative treatment for stress urinary incontinence. However, treatment involves more than simply performing repeated pelvic floor contractions.
Your program should address the specific findings from your assessment. Treatment may include:
- an individualised pelvic floor muscle training program
- improving pelvic floor strength and endurance where required
- practising appropriate muscle relaxation and coordination
- improving pelvic floor timing during coughing, lifting or exercise
- breathing and pressure-management strategies
- bowel advice when constipation or straining contributes
- graded strengthening and functional exercise
- modification and progression of running, jumping, gym or sporting activities
- real-time ultrasound retraining when useful for muscle awareness and coordination
- discussion of support options such as a pessary when clinically appropriate
If symptoms remain troublesome despite appropriate conservative management, your doctor may recommend further investigation or specialist review.
Pelvic Floor Exercises for Stress Incontinence
Pelvic floor exercises work best when they match your individual muscle function and symptoms. Some people need to improve strength or endurance. Others need better timing, coordination or awareness of when to activate and relax their pelvic floor.
A physiotherapist can check whether you are using the intended muscles and prescribe an appropriate starting level. Your program can then progress towards the activities that matter to you.
Learn more about pelvic floor exercises and pelvic floor rehabilitation.
How Long Does Improvement Take?
Improvement usually requires regular training over time. Pelvic floor rehabilitation may involve changes in strength, endurance, coordination, automatic muscle activation and movement habits.
Your progress will depend on your starting point, contributing factors, consistency with rehabilitation and the demands of the activities you want to perform. Your physiotherapist can reassess your progress and adjust the program as your control improves.
Can You Return to Running, Gym or Sport?
Stress incontinence does not automatically mean that you need to stop exercise. However, leakage during running, jumping or lifting can indicate that the current activity demand exceeds your continence system’s capacity.
Rehabilitation may therefore include graded strengthening, pressure-management strategies and progressive exposure to the movements that trigger your symptoms. The aim is to build capacity for the activities you want to perform rather than simply avoiding them.
When Should You Seek Help?
Consider an assessment if urine leakage:
- keeps recurring
- affects exercise, work or daily activities
- causes you to avoid activities
- affects your confidence or quality of life
- does not improve with self-management
- occurs alongside significant urgency or other bladder symptoms
Related Women’s Health Information
Frequently Asked Questions About Stress Incontinence
Can pelvic floor exercises help stress incontinence?
Pelvic floor muscle training is commonly used as conservative treatment for stress incontinence. An individual assessment can help determine whether your program should focus on strength, endurance, timing, coordination or other contributing factors.
What is the difference between stress and urge incontinence?
Stress incontinence causes leakage during physical pressure or effort, such as coughing, sneezing, lifting or exercise. Urge incontinence is associated with a sudden, difficult-to-delay need to pass urine. Some people experience both.
Why do I leak urine when I cough or sneeze?
Coughing and sneezing rapidly increase abdominal pressure. Leakage can occur when the pelvic floor and urethral support system cannot respond sufficiently to that pressure.
Can running or jumping cause urine leakage?
Running, jumping and other high-impact activities can trigger stress incontinence in some women. Assessment can help identify contributing factors and guide a graded rehabilitation program towards your exercise or sporting goals.
What happens at a pelvic floor physiotherapy appointment?
Your physiotherapist will discuss your symptoms, bladder and bowel habits, health history, exercise and goals. They will explain appropriate assessment options and obtain your consent before any physical assessment.
When should I see a doctor about urine leakage?
Medical assessment is appropriate for new or unexplained urinary symptoms, particularly when leakage occurs with blood in the urine, pain when passing urine, difficulty emptying the bladder or other concerning symptoms.
What to Do Next
If you leak urine with coughing, sneezing, lifting, running or other exercise, a women’s health physiotherapy assessment can help identify the factors contributing to your symptoms.
Your physiotherapist can assess your pelvic floor function and develop a rehabilitation program matched to your goals, whether that involves everyday activities, post-pregnancy recovery, gym training, running or return to sport.
References
- Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10(10):CD005654.
- NICE. Urinary incontinence and pelvic organ prolapse in women: management. National Institute for Health and Care Excellence.
- Bo K, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on terminology for conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourol Urodyn. 2017;36(2):221-244.
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