Stress urinary incontinence is the involuntary leakage of urine during times of increased abdominal stress or pressure. This increased abdominal pressure occurs during events such as coughing, laughing, and sneezing. It is a common disorder that has significant health, economic and quality of life ramifications.

Stress urinary incontinence affects 5-30% of adult women. The severity can range from leakage of a few drops of urine once or twice a month up to leakage of larger amounts several times a day. Occasional leakage of a few drops can be annoying but recurrent, persistent leakage can be distressing, contribute to other gynecologic problems and impact the quality of life.
The primary risk factor for stress incontinence is childbirth and pregnancy. In reproductive aged women, more than 50% of the cases of urinary incontinence can be attributed to pregnancy and childbirth. Women who deliver naturally are 3 times more likely to develop incontinence. Pregnancy itself is a risk factor, but the problem can be exacerbated when the pelvic floor is damaged as a result of birth. Other risk factors include age, obesity, menopause, pelvic injury, genetic or congenital issues, chronic cough and chronic constipation.

In the normal or continent women, the muscles of the urethra and pelvic floor work in coordination to store urine and evacuate at an appropriate times. Childbirth or other factors can damage the nerves and muscles resulting in weakness and dysfunction. The muscles of the urethra and pelvic floor become too weak and cannot prevent the forceful expulsion of urine that occurs with a hard cough or sudden sneeze. This is called stress urinary incontinence. In some cases the nerve damage makes it difficult for the bladder to sense when it is full or prevents the bladder from sending the correct message to the brain. Uninhibited bladder contractions may lead to unplanned bladder emptying. This is called urge incontinence.

The damage from childbirth usually improves over time and this is usually seen within one year of birth. Most women report some degree of incontinence during pregnancy and after birth this tends to resolve. The muscles and nerves either recover completely or learn to compensate. Recurrent births, age and other factors may inflict further damage on the muscles and they then may cross the threshold where compensation is no longer possible and the incontinence becomes a persistent problem which gradually worsens. Pelvic muscle exercises before pregnancy, during pregnancy and after delivery has been shown to help minimize this problem however this practice has not been routinely recommended.

Stress urinary incontinence is a distressing condition but for many it is a minor problem. Pelvic exercise can be useful in preventing this problem in many cases. For those who develop the condition, effective treatment is available and there is on-going research aimed at developing preventative strategies and more effective treatment options.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!