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Stress incontinence

Last updated: October 16, 2020

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Stress incontinence is the involuntary leakage of urine following any activity associated with raised intra-abdominal pressure (e.g., coughing, sneezing). It is twice as common in women than in men and its prevalence increases with age. Stress incontinence can be caused by a variety of conditions (e.g., pelvic floor weakness, intrinsic sphincter deficiency, etc.), the underlying mechanism of which is an increase in bladder pressure that exceeds sphincter resistance, which leads to expelling of urine. Individuals with the condition have predictable, small-volume urinary loss, typically during physical exertion, with no history of irritative symptoms of the bladder (urgency or frequency). Diagnosis is based on physical examination, a detailed medical history, and imaging studies. Treatment usually consists of leakage management measures (diapers, catheterization, etc.), drugs (anticholinergics), and in severe cases, surgery (sling operations, taping, etc.).

Epidemiological data refers to the US, unless otherwise specified.

  • Physical activity that causes increased intra-abdominal pressure (e.g., laughing, sneezing, coughing, exercising) leads to loss of urine
  • Frequent, predictable, small-volume urine losses with no urge to urinate prior to the leakage

The differential diagnoses listed here are not exhaustive.

Conservative treatment

Surgical procedures

  • Indicated if conservative treatment does not provide sufficient improvement of symptoms
  • Procedure of choice: midurethral sling to elevate the urethra
  • Alternative: urethropexy
    • Surgical fixation of a displaced urethra and bladder neck to nearby tissue to prevent involuntary urine leakage
    • Formerly the gold standard (before the introduction of midurethral slings) but now used less because it requires laparotomy or laparoscopy and is associated with more complications
    • Mainly reserved for patients who also require repair of pelvic organ prolapse
  • Less common alternatives
    • Periurethral bulking therapy
    • Artificial urinary sphincter placement
    • Bladder neck suspension
      • Tension-free vaginal tape (TVT)
      • Transobturator tape (TOT)
  1. Gita Guin, Abha Choudhary, Ruchita Dadhich. Prevalence of stress urinary incontinence and its associated risk factors amongst females attending tertiary referral centre. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2018 .
  2. Salam MA. Principles and Practice of Urology. Jaypee Brothers Medical Publishers (P) Ltd ; 2013
  3. Stress Urinary Incontinence in Women. http://www.urology-textbook.com/stress-urinary-incontinence-women.html. Updated: August 21, 2017. Accessed: November 30, 2017.