10th March, 20228 min read

Stress incontinence: how to stop it

Medical reviewer:
Dr Ann Nainan
Dr Ann Nainan
Dr Adiele Hoffman
Dr Adiele Hoffman
Author:
Charlotte Haigh
Charlotte Haigh
Last reviewed: 04/03/2022
Medically reviewed

All of Healthily's articles undergo medical safety checks to verify that the information is medically safe. View more details in our safety page, or read our editorial policy.

If you leak pee (urine) when you cough, laugh or lift something heavy, it’s likely that you have a type of urinary incontinence called stress incontinence.

This has nothing to do with feeling stressed. It happens when your bladder is put under some kind of extra pressure, such as when you sneeze, jump or have sex. You may leak just a small amount of pee, or you may lose larger amounts – especially when your bladder is full.

If this starts happening, it may feel distressing, embarrassing or frustrating. Fortunately, however, there are some simple steps you can take to manage stress incontinence – so don’t put up with it! Read on to learn why and how it happens, and what you can do to help treat it.

Who gets stress incontinence, and what happens?

Stress incontinence is very common. It makes up half of all cases of urinary incontinence in women, with some estimates suggesting that at least 1 in 3 women will be affected at some point in their life. You’re also more likely to get it as you get older – 1 in 5 women over 40 have some amount of stress incontinence.

As well as having an impact on your self-esteem, it can affect your daily life. It may mean you start avoiding activities such as exercise and sex, or don’t enjoy them because you’re anxious about leaks. Mixed incontinence – when you also have urge incontinence – can have an especially negative effect on your confidence and mood.

But avoiding activities that are healthy and pleasurable will affect your overall quality of life. And in any case, you can’t do anything about some of the common triggers for leaks, such as sneezing and coughing. But what you can do is help manage the problem with proven self-care tips and treatments.

Why am I leaking and wetting myself?

Stress incontinence can happen when either of the 2 types of muscles that usually stop you peeing are weakened or damaged. These muscles are:

  • pelvic floor muscles – these stretch across the base of your pelvis, from your vagina to your bottom, and support your pelvic organs, including your bladder
  • the ring of muscle that keeps your pee tube (urethra) closed, called your urethral sphincter (this works in the same way as your anal sphincter does for poo)
  • As your bladder fills up, these muscles should hold in your pee until you’re ready to go to the toilet. But if they’re damaged or weak, they can’t stay closed when there’s sudden extra pressure on your bladder – such as when you sneeze – and some pee leaks out.

What causes stress incontinence in women?

If you’re leaking when you cough, sneeze, laugh, exercise or lift things and it’s affecting your lifestyle, it’s worth talking to your doctor about stress incontinence. You’re more likely to have stress incontinence if you have any of these risk factors:

You’re pregnant or you’ve given birth

It’s estimated that 4 in 10 women get some amount of urinary incontinence in pregnancy and after the birth. During pregnancy, the weight of your growing baby stretches and weakens your pelvic floor muscles, and giving birth can then damage these muscles.

Vaginal delivery (particularly assisted delivery) is more strongly linked to stress incontinence than Caesarean delivery. But it can happen no matter what type of delivery you have.

You’re overweight or obese

Carrying extra weight increases pressure in your tummy (abdomen), which can weaken your pelvic floor muscles. The more overweight or obese you are, the worse your incontinence symptoms are likely to be.

You smoke

A cigarette habit can raise your risk of stress incontinence, although this is mainly in the longer term. Studies show that smokers over 60, usually with chronic obstructive pulmonary disease (COPD), are particularly affected.

This is probably due to long-term (chronic) coughing, which puts pressure on your pelvic floor muscles over time. So it’s another great reason to quit smoking.

You do a lot of high-impact exercise

Over time, ‘high-impact’ exercise that involves running and jumping can cause your pelvic floor muscles to stretch and weaken, and can also put pressure on the urethral sphincter.

Studies have found that high-impact activities such as skipping and trampolining are most likely to cause leaks, while exercises such as squats and burpees – where you use your pelvic floor and abdominal muscles together – can cause bigger leaks.

Some research suggests these kinds of exercise may play a role in the development of stress incontinence, and that the more exercise you do from a young age, the more likely you are to get stress incontinence later in life – although more research is needed to understand this.

Physical activity is important for overall wellbeing and can help you keep to a healthy weight (being overweight is a potential risk factor for stress incontinence). So rather than stopping your favourite exercise take other steps to keep your pelvic floor strong and manage your risk.

You have certain health conditions

Some medical conditions are also linked to stress incontinence, including stroke, multiple sclerosis (MS) and connective tissue disorders such as Ehlers-Danlos syndrome. This is because these conditions may cause problems with the muscles in your pelvic floor and urethra.

You’re menopausal

A drop in your levels of the hormone oestrogen, which happens during the menopause, can play a part in the weakening of your pelvic floor muscles. However, research suggests menopause is unlikely to be the only cause of stress incontinence.

You’ve had a hysterectomy

Having an operation to remove your womb (hysterectomy) may sometimes be linked to stress incontinence. This is because it can sometimes lead to bladder prolapse or, less commonly, nerve damage, and both of these things have been connected to pelvic floor weakening.

However, the link isn’t well understood, and researchers suggest that it’s probably a contributing factor, rather than a single cause of pelvic floor problems.

How is stress incontinence diagnosed?

If you’re not sure whether you need to see your doctor, you can use our Smart Symptom Checker to get information about your symptoms and recommended next steps.

However, it’s a good idea to see a doctor about stress incontinence if it’s affecting your quality of life or mental health, or if self-care measures haven’t helped.

As it’s such a common problem, your doctor will have seen lots of other women with stress incontinence, so there’s no need to feel embarrassed. And they can offer support in a number of ways. They’ll start by asking questions and may diagnose you based on your symptoms alone, or refer you for a few tests.

Find out more about when to see a doctor and how urinary incontinence is diagnosed – including when your symptoms suggest you should get urgent medical help. You should go to the emergency department if you have very bad tummy pain or a high temperature (fever), you’re suddenly unable to pee, or you suddenly can’t control when you pee or poo.

How can stress incontinence be managed and treated?

There are various types of support and treatment available for stress incontinence, which have a good track record of reducing or stopping the problem for the majority of women who use them. The best option for you will depend on your symptoms, health history and preference.

Woman exercising

Lifestyle changes

To start with, your doctor will probably recommend some lifestyle steps that can help. For stress incontinence, it’s particularly important to lose weight if you need to. Research shows that overweight and obese women who lose weight notice a significant drop in the number of leaks they have.

Read about other self-care measures for urinary incontinence.

Pelvic floor exercises

Weak pelvic floor muscles are a major underlying reason for stress incontinence, so strengthening them can help control leaks. Find out how to get the most from pelvic floor exercises for incontinence.

Pelvic floor exercises can take time to be effective, and you may need to do them for 3 months to notice a difference. In the meantime, you may want to use incontinence products to help manage leaks.

Non-surgical treatments

In some cases, you may be referred to a continence service or specialist physiotherapist, where you’ll be offered other non-surgical treatments for stress incontinence. Read more about urinary incontinence treatment without surgery.

Surgery and procedures

If other steps and treatments don’t help or aren’t suitable for you, your doctor may suggest you consider a surgical procedure to give your bladder more support. Read about surgery for urinary incontinence in women.

Your health questions answered

Isn’t stress incontinence something I just have to put up with?

“Not at all. Stress incontinence may be common, but that doesn’t mean it has to be a normal part of having children or getting older. A lot of women think they have to cope on their own, but there’s a lot that you and your doctor can do – so don’t hesitate to see them, even if you think the problem isn't that serious. If it affects your wellbeing or daily life, and stops you enjoying things – from Zumba classes to sex, watching a good comedy or gardening – then get the help you need.”

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