Stress urinary incontinence

Overview

Stress urinary incontinence (SUI) is when you accidentally leak urine when you put sudden pressure on your bladder. This can happen when you cough, sneeze, laugh, exercise, or lift something heavy.

Yes, stress urinary incontinence is common. It affects people of all ages, but it is most common in women, particularly after childbirth or menopause.

SUI can affect anyone, but it is more common in women. People who have had children, are overweight, or have had pelvic surgery are at higher risk.

Symptoms

Common symptoms

• Leaking urine when coughing, sneezing, laughing, or exercising
• Leaking a small amount of urine when lifting something heavy
• Leaking during activities that increase pressure in the belly

Symptoms in children

• Stress incontinence is less common in children. However, children may leak urine when they cough, laugh, or play hard.
• If a child has symptoms, it is important to see a doctor to rule out other causes.

Symptoms in older adults

• Older adults may also experience SUI, often due to weakened pelvic floor muscles or mobility issues.
• In older adults, leakage may happen with simple movements like standing up or walking.

Causes

Main causes

• Weakened pelvic floor muscles: these muscles support the bladder and urethra (the tube that carries urine out of the body)
• Damage to the muscles or nerves that control the bladder, often from childbirth or surgery
• High pressure inside the belly from being overweight, having a chronic cough, or lifting heavy objects

Risk factors

• Giving birth, especially vaginally or to a large baby
• Getting older
• Being overweight or obese
• Smoking (which causes a chronic cough)
• Having previous pelvic surgery or radiation therapy

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe pelvic pain or cannot urinate
• If you see blood in your urine

Book a routine appointment if:

• If you leak urine often and it bothers you
• If you leak urine during daily activities
• If you feel like you need to talk about treatment options

Diagnosis

A doctor will talk with you about your symptoms and examine you. They may ask you to keep a bladder diary for a few days so they can see when you leak.

Tests that may be done

• A urine test (to check for infection or blood)
• A test to measure how much urine you leak (called a pad test)
• A test to check how well your bladder empties (ultrasound scan)

What to expect at your appointment

You may be referred to a specialist, like a urologist (bladder doctor) or a pelvic floor physiotherapist. They will work with you to find the best way to manage your symptoms.

Treatment

Treatment for stress urinary incontinence usually starts with simple steps that you can do at home. If those don’t help enough, your doctor may suggest other treatments.

Self-care at home

• Do pelvic floor muscle exercises (Kegel exercises) every day to strengthen the muscles that support your bladder.
• Train your bladder by going to the toilet on a schedule and not going too often.
• Maintain a healthy weight to reduce pressure on your bladder.
• Avoid heavy lifting, or use good lifting techniques.

Medical treatments

If self-care isn’t enough, your doctor may suggest other options. These include: a small vaginal device (pessary) that supports the bladder, electrical stimulation to help strengthen pelvic muscles, or a treatment that uses sound waves to tighten the urethra. In some cases, medicine may be prescribed, but it works better for other types of incontinence. Always talk to your doctor about what is right for you.

When is surgery considered?

If your symptoms are severe and other treatments haven’t worked, surgery may be an option. Common procedures include a sling (a strip of material that supports the urethra) or a bulking agent injection around the urethra. Your doctor will explain the risks and benefits.

Living with this condition

Living with stress incontinence can be challenging, but you can take simple steps to manage it. Use pads or protective underwear to feel more confident. Plan bathroom breaks before activities, and stay hydrated but not overhydrated.

Lifestyle tips

• Stay active, but modify exercises that cause leaking (for example, do low-impact activities like walking or swimming).
• Wear dark clothes or a waterproof cover to feel comfortable.
• Start a pelvic floor exercise routine – it can make a big difference.

Diet and exercise

Eating a healthy diet can help. Avoid constipation by eating plenty of fiber, as straining on the toilet can weaken pelvic muscles. Doing regular, gentle exercise like walking or Pilates can keep your core strong without too much pressure on your bladder.

Mental health and emotional wellbeing

It is normal to feel embarrassed, frustrated, or anxious about leaking. Remember, you are not alone. Talking to a friend, family member, or a counselor can help. If you feel very sad or hopeless, tell your doctor – they can support you.

Prevention

You can lower your chance of developing stress urinary incontinence by keeping a healthy weight, doing pelvic floor exercises (especially during and after pregnancy), and avoiding heavy lifting. Quitting smoking also helps because it reduces chronic coughing.

Screening programmes

There is no routine screening test for SUI, but if you have symptoms, your doctor can assess your risk and offer advice.

Complications

If left untreated

• Skin problems around the vulva or groin from constant moisture
• Urinary tract infections from bacteria getting into the bladder
• Feeling isolated or avoiding social activities

Long-term outlook

The outlook is good. Many people see improvement with simple self-care and exercises. Even if symptoms persist, there are many effective treatments. You don’t have to live with the problem – help is available.

Find support

International organisations

• International Continence Society

Local organisations

• Your local health service or continence clinic · UK

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