How to stop stress incontinence?

Urinary incontinence (UI), or the involuntary leaking of urine, can have an extreme effect on an individual’s ability to participate in their everyday life. It has been reported that 25-45% of women experience UI.1 While incontinence is more prevalent in women, both sexes can be affected.  The taboo nature of the topic prevents many of these sufferers from finding the remedies they need in order to get back to their normal lives.

There are different types of UI, including stress, urge, functional, and overflow. The most common type, which we will be discussing here, is stress incontinence. This occurs when a person leaks urine during exertion or “bearing down.” This type of UI can happen while coughing, sneezing, lifting, laughing, or moving suddenly.  Essentially, the pressure in the abdomen increases during these activities, resulting in the involuntary leakage of urine.

To know how to solve this problem, we need to understand the potential causes of stress UI. Having a high body mass index (BMI), diabetes, or history of pelvic surgery or smoking can increase the risk of incontinence.2 However, the most common risk factor for UI is pregnancy and childbirth. Childbirth often has traumatic effects on a woman’s pelvic floor musculature. These are the muscles that are responsible for sexual function as well as controlling the bladder and bowel. After childbirth, the muscles can become physically torn and damaged. More importantly, the individual can temporarily lose partial or complete voluntary control of the muscles, which causes UI.

So what can be done to remedy incontinence? There are several different methods that have been shown to reduce or resolve UI. Extreme cases of UI may require surgical or pharmaceutical interventions. Since these interventions are associated with risks such as surgical complications, infections, and negative side effects, it is important for both the patient and physician to consider them only as a “last resort” in management of UI.  Several conservative methods exist and have been shown to be safe and effective.

 

Kegels: 

The kegel is one of the most common and easy interventions for UI. However, it is an exercise that can be difficult to both explain and to complete. One way to think of this exercise is to imagine urinating and then contracting in order to stop the flow of urine. Hold this contraction for about five seconds and then relax and repeat. The benefit of this exercise is that it can be done easily and subtly throughout the day.

 

Physical therapy:

Since stress UI occurs when a person “bears down” and increases pressure in the trunk, improving strength and control of trunk muscles can decrease symptoms of UI.3 Specifically, exercises focusing on the diaphragm, lower back, and abdominals will increase overall stability of the trunk so that “bearing down” activities will be less likely to cause a leak. Attending physical therapy for a full assessment and assistance with these exercises may be beneficial to ensure that exercises are done safely and correctly.

 

Weight loss:

It has been found that have a high body mass index and waist circumference increase risk of UI4. Basically, having more weight around the belly increases pressure in the abdomen, increasing risk of leaking. Not only is weight loss an effective strategy to reduce UI, it has numerous benefits on overall health.

 

Voiding schedules:

Some individuals with incontinence find it helpful to develop a voiding schedule to ensure that urine is eliminated on a regular basis. For example, one might use a 2-hour timer as a reminder to use the bathroom throughout the day. The ideal amount of time would vary depending on an individual’s activity levels and intake of food and drink.

 

Electrical stimulation and biofeedback tools:

While these tools can be purchased and used privately, it may be nerve-wracking to try without guidance.  Physical therapists and other health care professionals can administer these treatments as well.


Electrical stimulation involves stimulation of pelvic floor muscles via electrodes placed on the skin, causing the muscles to contract. It is intended for use in individuals who have trouble contracting these muscles voluntarily. Over time, this method is meant to increase strength and the ability of these muscles to contract voluntarily.


Biofeedback is a tool that measures the amount of electrical activity of the pelvic floor muscles. While using a biofeedback machine, the individual is able to see the strength of their contractions. This method of feedback increases the voluntary control of the pelvic floor by guiding the individual to contract the correct muscles and to increase the strength of contraction with practice.

 

Vaginal cones and toning balls:

Vaginal cones are small weighted tools that are designed to re-train pelvic floor musculature. At first, a cone of low weight is inserted in the vagina and the individual contracts to hold the weight in place. Gradually the weight of the cone is increased to accommodate the increasing strength and control of the pelvic floor. The tools are easily accessible and easy to use.
Toning balls are products that usually made of metal covered in a rubber coating. These products, such as the Ben Wa Ball, propose to improve effectiveness of the kegel exercise by providing a sensory cue to the vaginal wall or resistance to the vaginal musculature.

 

Pessaries:

Pessaries are tools that are inserted into the vagina in order to provide support to internal structures. In the case of UI, pessaries are usually inserted in such a way to provide pressure against the urethra. With the device in place, urine should not leak, even when the individual bears down. Depending on severity and frequency of UI, these devices can be kept in place only during strenuous activity or throughout the day as needed.

 

Diet:

  • Bladder irritants: There are several known foods and beverages that are considered bladder irritants. These include caffeine, alcohol, milk, chocolate, sugar, and several citrus fruits among others. It is important to limit consumption of these items in individuals with UI in order to decrease the urge to urinate.
  • Dehydration: Dehydration can also increase urge to urinate since urine becomes more potent when the body lacks water.
  • Supplements: Vitamin D supplementation has been shown to reduce vaginal atrophy in post-menopausal women5 and to decrease risk of pelvic floor disorders6.

 

Apps:

Welcome to UI in the digital age! Several apps exist that can aide in the management of UI.

  • Exercise apps: Use Tät or Kegel Trainer to work your way through pelvic floor exercises.
  • UI Diary apps: Uro Bladder Diary and BladderPal help you to track your voiding and incidence of UI.
  • Perifit: For a more comprehensive approach, the Perifit system is a combination of an internal sensor and smartphone app that allows you to assess your pelvic floor strength, play exercise games, and track your progress over time.


Urinary incontinence is a major problem affecting a substantial proportion of the population. Luckily the wide variety of available treatment interventions allows UI sufferers and their doctors to choose a method to reduce symptoms of UI or eliminate the issue altogether. Use these methods to let UI be a thing of the past and get back to living your life!

 

 

References:

1.     Buckley BS, Lapitan MCM. Prevalence of Urinary Incontinence in Men, Women, and Children—Current Evidence: Findings of the Fourth International Consultation on Incontinence. Urology. 2010;76(2):265-270. doi:10.1016/j.urology.2009.11.078.
2.     Kaphingst KA, Persky S, Lachance C. Risk Factors for Urinary Incontinence among Middle-aged Women. Am J Obs Gynecol. 2006;194(2):339-345. doi:10.1080/10810730902873927.Testing.
3.     Olza J, Gil-Campos M, Leis R, Bueno G, Aguilera CM, Valle M, Cañete R TR, Moreno LA G a. Pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence: randomized controlled pilot trial of supervised versus unsupervised training. 2011:132-141. doi:10.4254/wjh.v5.i4.196.
4.     Townsend MK, Danforth KN, Rosner B, Curhan GC, Resnick NM, Grodstein F. Body Mass Index, Weight Gain, and Incident Urinary Incontinence in Middle-Aged Women. Obstet Gynecol. 2007;110(2, Part 1):346-353. doi:10.1097/01.AOG.0000270121.15510.57.
5.     Yildirim B, Kaleli B, Düzcan E, Topuz O. The effects of postmenopausal Vitamin D treatment on vaginal atrophy. Maturitas. 2004;49(4):334-337. doi:10.1016/j.maturitas.2004.02.008.
6.     Chang, W S, Lee, YJ, Lu F. Role of Vitamin D in urogenital health of geriatric participants. 2017:28-35. doi:16167509.