Overview

Urinary incontinence is the unintentional loss of urine. Stress incontinence happens when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine. Stress incontinence is not related to psychological stress.

Stress incontinence is different from urgency incontinence and overactive bladder (OAB). If you have urgency incontinence or OAB, your bladder muscle contracts, causing a sudden urge to urinate before you can get to the bathroom. Stress incontinence is much more common in women than in men.

If you have stress incontinence, you may feel embarrassed, isolate yourself, or limit your work and social life. You may also avoid physical and leisure activities. With treatment, you'll likely be able to manage stress incontinence and improve your overall well-being.

Stress incontinence care at Mayo Clinic

Symptoms

If you have stress incontinence, you may leak urine when you:

  • Cough or sneeze
  • Laugh
  • Bend over
  • Lift something heavy
  • Exercise
  • Have sex

You may not experience incontinence every time you do one of these things, but any activity that increases pressure on your bladder can make you more vulnerable to unintentional urine loss, particularly when your bladder is full.

When to see a doctor

Talk to your doctor if your symptoms are bothersome or interfere with daily activities, such as your work, hobbies and social life.

Causes

Stress incontinence occurs when the muscles and other tissues that support the urethra (pelvic floor muscles) and the muscles that control the release of urine (urinary sphincter) weaken.

The bladder expands as it fills with urine. Normally, valve-like muscles in the urethra — the short tube that carries urine out of your body — stay closed as the bladder expands, preventing urine leakage until you reach a bathroom. But when those muscles weaken, anything that exerts force on the abdominal and pelvic muscles — sneezing, bending over, lifting or laughing hard, for instance — can put pressure on your bladder and cause urine leakage.

Your pelvic floor muscles and urinary sphincter may lose strength because of:

  • Childbirth. In women, tissue or nerve damage during delivery of a child can weaken the pelvic floor muscles or the sphincter. Stress incontinence from this damage may begin soon after delivery or occur years later.
  • Prostate surgery. In men, the surgical removal of the prostate gland to treat prostate cancer (prostatectomy) is the most common factor leading to stress incontinence. This procedure can weaken the sphincter, which lies directly below the prostate gland and encircles the urethra.

Contributing factors

Other factors that may worsen stress incontinence include:

  • Illnesses that cause chronic coughing
  • Obesity
  • Smoking, which can cause frequent coughing
  • High-impact activities, such as running and jumping, over many years

Risk factors

Factors that increase the risk of developing stress incontinence include:

  • Age. Physical changes that occur as you age, such as the weakening of muscles, may make you more likely to develop stress incontinence. However, occasional stress incontinence can occur at any age.
  • Type of childbirth delivery. Women who've had a vaginal delivery are more likely to develop urinary incontinence than women who've delivered via a cesarean section. Women who've had a forceps delivery to more rapidly deliver a healthy baby may also have a greater risk of stress incontinence. Women who've had a vacuum-assisted delivery don't appear to have a higher risk for stress incontinence.
  • Body weight. People who are overweight or obese have a higher risk of stress incontinence. Excess weight increases pressure on the abdominal and pelvic organs.
  • Previous pelvic surgery. Hysterectomy in women and surgery for prostate cancer in men can weaken the muscles that support the bladder and urethra, increasing the risk of stress incontinence.

Complications

Complications of stress incontinence may include:

  • Emotional distress. If you experience stress incontinence with your daily activities, you may feel embarrassed and distressed by the condition. It can disrupt your work, social activities, relationships and even your sex life. Some people are embarrassed that they need pads or incontinence garments.
  • Mixed urinary incontinence. Mixed incontinence is common and means that you have both stress incontinence and urgency incontinence — the unintentional loss of urine resulting from bladder muscle contractions (overactive bladder) that cause an urgent need to urinate.
  • Skin rash or irritation. Skin that is constantly in contact with urine may get irritated or sore and can break down. This happens with severe incontinence if you don't take precautions, such as using moisture barriers or incontinence pads.