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Causes

By Mayo Clinic staff

CLICK TO ENLARGE

Illustration of the female urinary system Female urinary system
Illustration of the male urinary system Male urinary system

Stress incontinence occurs because of poor function in the muscles that support the bladder or control the release of urine. Sometimes both muscle groups are involved. The bladder expands as it fills with urine, but valve-like muscles at either end of the urethra — the short tube through which urine flows to exit your body — normally stay "closed" or contracted, preventing urine release until you reach a bathroom. When the muscles supporting the bladder are weak, however, pressure can trigger urine release before you're ready. Problems with the "valves" themselves (the urinary sphincter) may have the same effect.

Your bladder may not even feel unusually full when you have urine leakage due to stress incontinence. Anything that exerts force on the abdominal muscles — sneezing, bending over, lifting, laughing hard — also puts pressure on your bladder.

Your urinary sphincter and pelvic floor muscles may lose tone because of:

  • Childbirth. In women, poor function of pelvic floor muscles or the sphincter may occur because of tissue or nerve damage incurred during delivery of a child. Stress incontinence from this damage may begin soon after delivery or years later.
  • Prostate surgery. In men, the most common factor leading to stress incontinence is the surgical removal of the prostate gland (prostatectomy) to treat prostate cancer. Because the prostate gland encircles the urethra, a prostatectomy results in less urethral support.

Contributing factors
Other factors that may exacerbate stress incontinence include:

  • Urinary tract infection
  • Illnesses that cause chronic coughing or sneezing
  • Obesity
  • Smoking, which can cause frequent coughing
  • Diabetes, which can cause excess urine production and nerve damage
  • Excess consumption of caffeine or alcohol
  • Medications that cause a rapid increase in urine production
  • Sports, such as tennis or running
Risk factors Symptoms
References
  1. DuBeau CE. Clinical presentation and diagnosis of urinary incontinence. http://www.uptodate.com/home/index.html. Accessed Sept. 9, 2008.
  2. DuBeau CE. Patient information: Urinary incontinence. http://www.uptodate.com/patients/content/topic.do?topicKey=~/0j/LeBKevVnHo. Accessed Sept. 9, 2008.
  3. Urodynamic testing. National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/kudiseases/pubs/urodynamic/index.htm. Accessed Sept. 9, 2008.
  4. Norton P, et al. Urinary incontinence in women. The Lancet. 2006;367(9504):57-67.
  5. Holroyd-Leduc JM, et al. Management of urinary incontinence in women: Scientific review. Journal of the American Medical Association. 2004;291(8):986-995.
  6. Norton PA. Female urinary incontinence: Epidemiology and evaluation. In: Gibbs RS, et al. Danforth's Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:870-876.
  7. DuBeau CE. Patient information: Urinary incontinence treatments. http://www.uptodate.com/patients/content/topic.do?topicKey=~aup1.o0ho/j5Wk. Accessed Sept. 9, 2008.
  8. Baharak A, et al. Nonsurgical management of urinary incontinence and overactive bladder. In: Gibbs RS, et al. Danforth's Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:890-899.
  9. Rogers RG. Urinary stress incontinence in women. The New England Journal of Medicine. 2008;358(10):1029-1036.
  10. Nager CW, et al. Operative management of urinary incontinence. In: Gibbs RS, et al. Danforth's Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:877-889.
  11. Costa P, et al. Advancing the treatment of stress urinary incontinence. BJU International. 2006;97(5):911-915.
  12. Khan F, et al. Surgical treatment of stress urinary incontinence in women. http://www.uptodate.com/home/index.html. Accessed Sept. 9, 2008.
  13. Urodynamic testing. National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/kudiseases/pubs/uimen/index.htm. Sept. 9, 2008.
  14. Rapp DE, et al. Surgical technique using AdVance sling placement in the treatment of post-prostatectomy urinary incontinence. International Brazilian Journal of Urology. 2007;33:231-237.
  15. Wolter CE (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 6, 2008.

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Oct. 17, 2008

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