If pelvic floor muscles aren’t strong enough to support a full bladder, they allow the sphincter to open and urine leaks out.
Stress urinary incontinence - accidental leaks when you cough, laugh or sneeze - is the most common form of urinary incontinence in women.
Stress urinary incontinence happens when your sphincter, which acts like a valve to the bladder, can’t stay closed when there’s pressure in your abdomen.
As a result, the sphincter opens slightly and allows a small amount of urine to leak out.
This means you can leak urine when you:
cough, laugh or sneeze
exercise (particularly jumping)
lift or do any movement that puts pressure on the bladder, eg bending
have sex (particularly when your partner’s penis enters your body).
In severe cases even walking or getting up out of bed or a chair can cause leaks.
You may also find that Stress Incontinence is worse during the week before your period. This is because hormones released by your body during that week have an effect on the muscles of your pelvic floor, which support the bladder and urethra.
Who gets Stress urinary incontinence?
It's estimated around one in three women get SUI at some point in their lives. It can happen at any age, although it's more common in women between the ages of 35 and 60.
Stress urinary incontinence is rare in men, and is usually a result of injury or prostate surgery.
What causes Stress urinary incontinence?
It's thought Stress urinary incontinence is due to weakness in the sphincter muscle and the pelvic floor muscles that support the organs in your pelvis and abdomen.
Things that can weaken the pelvic floor:
Pregnancy: carrying the increasing weight of baby in your pelvis over 40 weeks puts extra stress on your pelvic floor. Also, during pregnancy the hormone relaxin softens the muscles of the pelvic floor ready for the birth. Around half of pregnant women suffer from Stress urinary incontinence.
Childbirth: if you have a vaginal delivery, it’s possible the nerves around your pelvic floor become stretched and bruised. After delivery, they can’t make the pelvic floor work properly and the muscles may not respond as well. A Danish study of more than 2000 women found those who'd had a tear or episiotomy had a three-fold risk of developing urinary incontinence.
Being overweight: this means there’s more pressure on your abdomen, which in turn puts more pressure on your pelvic floor. A British study by Dallosso et al in 2002 found that women who were overweight were nearly twice as likely to have Stress urinary incontinence as someone of normal weight.
Hysterectomy: a hysterectomy is an operation to remove the womb (uterus). It can cause damage to the pelvic floor.
Smoking: having a chronic cough puts pressure on the pelvic floor and makes Stress urinary incontinence worse. Stop smoking and see your GP for help dealing with the cough.
Menopause: after the menopause your oestrogen levels are lower, which can mean muscle pressure around your urethra is weaker and leaks are more likely. Your urethra may be less elastic and less able to close completely. Postmenopausal women are also more likely to be overweight and have had a hysterectomy - themselves factors in Stress urinary incontinence.
An inherited weakness of the pelvic floor muscles, although this is rare.
Some medication can affect the pelvic floor. Examples are alpha-blockers used to treat high blood pressure, some antidepressants and sedatives, and some muscle-relaxant drugs.
Things that can damage the sphincter muscle:
A pelvic fracture.
Bladder neck surgery.
Radical prostatectomy (for men).
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