Stress Incontinence

Imagine you are holding on your hand a balloon full of water. The neck of the balloon is held closed between your fingers so that it does not leak. But if your fingers get tired and you squeeze the balloon just a little, the water will dribble out.

That is what happens to the bladder in the commonest type of problem involving leaking - "stress incontinence". If the valve at the neck of the bladder (the urinary sphincter) and the pelvic floor muscles are not strong enough, then an increase of pressure on the bladder may be too much for them, and you will find some urine has leaked out. This happens especially with a sudden increase of pressure, for example when you cough or laugh or take exercise.

Women have more trouble of this sort than men.  It is especially common during pregnancy and after childbirth.  Both pregnancy and childbirth put an enormous strain on the pelvic floor muscles and can leave them severely weakened and may damage the sphincter muscle.  (We produced a special leaflet about pregnancy and childbirth called "Expecting a Baby": see our publications list.)  The changes that occur after the menopause can aggravate the problem, as can excessive weight or a chronic or smoker’s cough.

Pelvic Floor Muscle Exercises

Fortunately, for most people the answer is simple: exercise.  Just as with other muscles, the more you exercise them the stronger they grow.  So it is important for anyone with signs of stress incontinence and especially for women who are pregnant or who have recently had children to give their pelvic floor muscles plenty of exercise.  You can find out how to do pelvic floor muscle exercises right now if you wish - click here. You will need to persist with them for some weeks - probably months - before you notice a substantial improvement, and you should keep them up for life, but for most people this is the way to overcome their problems.

Some people find that pelvic floor muscle exercises are easier or more effective if taught by a qualified practitioner such as a physiotherapist or a continence nurse specialist.  These experts may also advise trying techniques which reinforce the exercises. Details of these options are included with our descriptions of pelvic floor muscle exercises.

Sometimes surgery is appropriate: when it is undertaken, the rate of success is high.

Medication

There is a relatively new drug for the treatment of stress urinary incontinence called duloxetine (Yentreve™). Research shows that it can reduce the amount of incontinence experienced by women with the problem by about half in half of the women treated. It is thought to act by increasing the “tightness” of the valve in the urethra (the tube running form the bladder to the outside). The main side effect of the drug is nausea and vomiting, which for most women wears off after a week or so. This can be made more tolerable by starting the drug at a low dose and increasing this slowly. In spite of this, up to a quarter of women cannot tolerate the drug and have to stop it. The drug is closely related to commonly used anti-depressants and you should ask your doctor before taking the drug. Duloxetine is probably best used in combination with pelvic floor exercises, but it is better than no treatment if these cannot be performed.

• Pelvic floor exercises
• Surgery for stress incontinence in women