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National Continence week – Stresses and Urinary Incontinence

What is Stress Urinary Incontinence?

Stress urinary incontinence is the involuntary release of urine during laughter, coughing, lifting of objects or any movement that increases pressure on your bladder.

Urine is composed of water, electrolytes, and other waste material that has been filtered out of the blood in your kidneys. Urine is then transported via the ureters to your bladder, where it is stored. Once full, the muscles in the wall of your bladder contract forcing urine through the urethra and out of your body. Sphincter muscles and pelvic floor muscles keep the urethra closed to avoid leakage of urine. These muscles relax at the same time the bladder contracts in order to allow urine to exit your body.

What Causes Stress Urinary Incontinence?

It is caused by a lack of support to the bladder outlet, this is due to both pelvic floor and connective tissue weakness. These tissues act like a hammock to resist the downward pressure on the bladder during increased abdominal pressure e.g.- when coughing

There are several causes for stress urinary incontinence, these include:

Hormonal changes

During the week before your menstrual cycle, estrogen levels fall, causing symptoms of stress urinary incontinence to worsen. Additionally, as a woman goes through menopause, estrogen levels also fall causing the pelvic floor muscles to weaken. This results in less muscular pressure around the urethra, making stress urinary incontinence more likely.


If you are pregnant, you may experience stress urinary incontinence due to hormonal changes and the enlarging size of the uterus.

During pregnancy, estrogen levels are lower, leading to less muscular strength in the sphincter and pelvic floor muscles. Additionally, as the fetus grows extra weight is placed on your bladder.pregnancy


Vaginal delivery can damage your pelvic floor muscles making urine leakage more likely. The supporting tissues of your bladder can also be damaged during vaginal delivery causing a cystocele, or prolapse of your bladder, symptoms of which include urinary incontinence. You may not know you have suffered damage to your pelvic floor until after you have gone through menopause, when the pelvic floor muscles are further weakened due to a fall in estrogen levels.

Hysterectomy and other surgery

Some exercises will exacerbate a week pelvic floor, these include running, jumping or any high impact exercise. Other exercises which stress the pelvic floor include sit-ups and deep lunges.

The bladder and uterus are very close together and have common supporting ligaments and muscles. Surgery to, or removal of your uterus as in a hysterectomy, risks damage to the supporting structures of your bladder. If these supporting structures are damaged, a cystocele is likely to occur. Symptoms of a cystocele include urinary incontinence.


When you are ill and suffering from severe coughing, the pelvic floor muscles may fatigue and allow temporary stress incontinence due to an increase in abdominal pressure experienced while coughing.


Obesity can increase the abdominal pressure on the bladder leading to urinary incontinence.

How is Stress Urinary Incontinence treated?

Treatments of stress urinary incontinence are tailored to suit your individual problem. The following should be considered:

Pelvic floor muscle strengthening

Strengthening the supporting muscles of your bladder is very effective in helping stress urinary incontinence. Biofeedback, or the use of special computer equipment to measure muscle activity, can help improve muscle control. Electrical stimulation can also assist in strengthening the pelvic floor muscles.

  • Deep abdominal or core strengthening

Learning the knack – this is when you contract your pelvic floor and deep abdominal muscles prior to coughing (or whatever triggers your incontinence)

  • Lifestyle changes
  • Posture
  • Adjusting activities e.g.- avoid jumping until your symptoms improve
  • Weight loss if necessary
  • Vaginal splinting if necessary

Studies show 85% of women with Stress Incontinence are cured with Physiotherapy treatment

To prevent urinary incontinence, you should consider the following:

• Routine performance of pelvic floor muscle strengthening exercises

• Cessation of smoking

• Avoidance or correction of obesity, or chronic cough

• Increased daily intake of fiber and fluid to prevent constipation, a risk factor for urinary incontinence

• Avoidance of bladder irritants such as alcohol and caffeine

• Staying physically active. Individuals who are physically active are less likely to develop urinary incontinence

• Discussing the possibilities and risks of estrogen replacement therapy with your physician

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