Stress incontinence: causes, pelvic floor exercises and treatment

The NHS explains that urinary incontinence is the unintentional passing of urine, and that stress incontinence is when urine leaks at times when your bladder is under pressure, such as when you cough or laugh. It is one of the two most common types, along with urge incontinence. You can also have a mixture of both, which the NHS calls mixed incontinence.

The NHS says stress incontinence is when the pressure inside your bladder as it fills becomes greater than the strength of your urethra to stay closed. Any sudden extra pressure, such as laughing or sneezing, can then cause urine to leak.

The NHS says you leak urine when your bladder is put under sudden extra pressure, and that this is not related to feeling stressed. Activities that may cause leaks include coughing, sneezing, laughing, heavy lifting and exercise. The amount of urine passed is usually small, but it can sometimes be larger, particularly if your bladder is very full.

The NHS says stress incontinence is usually the result of weakening of or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter. Problems with these muscles may be caused by:

• damage during childbirth, particularly if your baby was born vaginally rather than by caesarean section

• increased pressure on your tummy, for example because you are pregnant or obese

• damage to the bladder or nearby area during surgery, such as removal of the womb (hysterectomy) or prostate gland

• neurological conditions that affect the brain and spinal cord, such as Parkinson's disease or multiple sclerosis

• certain connective tissue disorders such as Ehlers-Danlos syndrome

• certain medicines, such as ACE inhibitors, diuretics, some antidepressants, HRT and sedatives, which can disrupt storing and passing urine

The NHS lists pregnancy and vaginal birth, obesity, a family history of incontinence and increasing age as things that increase the chances of urinary incontinence, though incontinence is not an inevitable part of ageing. Being pregnant and giving birth can weaken the muscles that control urine flow. The NHS says that if you are pregnant, strengthening your pelvic floor muscles may help prevent urinary incontinence.

The NHS says treatment depends on the type and the severity of symptoms. Conservative treatments that do not involve medicines or surgery are tried first, which are lifestyle changes, pelvic floor muscle training and bladder training. After this, medicine or surgery may be considered.

The NHS says your pelvic floor muscles surround the bladder and urethra and control the flow of urine as you pee. A GP may refer you to a specialist to start a programme. The specialist will assess whether you can squeeze your pelvic floor muscles and by how much, and give you an exercise programme based on your assessment, which should include a minimum of 8 muscle contractions at least 3 times a day and last for at least 3 months. If the exercises are helping after this time, you can keep on doing them.

NHS continence services are centres staffed by specialist nurses, sometimes called continence advisers, and specialist physiotherapists. A GP can refer you to your local continence service and in some cases you may be able to refer yourself.

The NHS says that if non-surgical treatments are unsuccessful or unsuitable, surgery or other procedures may be recommended. You should discuss the risks and benefits with a specialist. If you plan to have a pregnancy, this will affect your options, as the physical strain of pregnancy and childbirth can sometimes cause surgical treatments to fail.

The NHS suggests maintaining a healthy weight, changing drinking habits including cutting down on alcohol, caffeine (tea, coffee and cola), and doing pelvic floor muscle exercises. If you have to urinate frequently at night, it suggests drinking less in the hours before bed while still drinking enough during the day. It says the recommended weekly limit for alcohol is 14 units.

The NHS says urinary incontinence can affect anyone, and damage to the bladder or nearby area during surgery, such as removal of the prostate gland, is a cause of stress incontinence. Pelvic floor muscle training is recommended for everyone with urinary incontinence, and an artificial urinary sphincter is used more often in people who have a penis.

The NHS says to see a GP if you have any type of urinary incontinence, as it is a common problem and you should not feel embarrassed. A GP will ask about your symptoms, may do a pelvic or rectal examination, and may suggest keeping a diary of how much fluid you drink and how often you urinate. You may be referred to a specialist for more tests. The NHS says some medicines can contribute to incontinence, and stopping them, if a doctor advises it, may help resolve it.

On the NHS, you can be seen by a GP and referred to a continence service for pelvic floor training, and then to a urogynaecology or urology team if surgery is considered. In some areas you may be able to refer yourself to the continence service. Some people choose private physiotherapy or urogynaecology for faster access. Ask about the type of operation proposed, the surgeon's experience and what complications could occur, as the NHS advises discussing risks and benefits with a specialist.