Stress incontinence involves the involuntary loss of urine due to failure of the urethra to provide a tight seal. Childbirth, chronic constipation, smoking, and being overweight all seem to predispose women to this problem. Patients with stress incontinence usually describe frequent leakage of small amounts of urine with coughing, sneezing, laughing, and physical activity. Although this is the most common form of incontinence for women in the 40 - 60 age range, older women are more likely to experience urge incontinence ("overactive bladder")or a mixed picture of stress and urge incontinence. Stress incontinence, like urge incontinence, has a major impact on a women's quality of life. Women with stress incontinence may withdraw from social activities they enjoy out of fear of embarrassment. Typically these patients will attempt to keep their bladders relatively empty by voiding frequently in hopes of reducing the amount of leakage they experience. Like patients with overactive bladder they will often map out the locations of bathrooms before leaving the house so as to allow frequent urination.

Ninety percent of patients with stress incontinence experience leakage because of a poorly supported urethra. The urethra is the opening to the bladder through which we urinate. Normally the urethra is attached to the muscles and bones of the pelvis by strong ligaments. These ligaments can be injured and weakened by childbirth, chronic constipation, a lifetime of heavy lifting, lack of estrogen, and smoking. Normally these ligaments hold the urethra firmly in place during times when the bladder experiences sudden increases in pressure, i.e. with coughing, sneezing, laughing etc. This results in a tight seal and prevents the leakage of urine. If urethral support is lost however the seal fails, and leakage occurs, each time the bladder pressure exceeds the urethra pressure. This mechanical problem has many solutions that are outlined in the treatment section of this document.

Ten percent of patients with stress incontinence leak for a different reason. This group of patients experience leakage because the urethra itself is weak. The urethra is a muscular tube that always maintains a certain tone or squeeze. This ensures that the urethral pressure at rest will always be greater than the bladder pressure and that urine will stay within the bladder until it is time to void. If that baseline level of squeeze is reduced the seal between the urethra and bladder will be lost with even minor physical activity. This condition is called "low pressure urethra" and can be somewhat more challenging to treat. Even so, most of these patients can be dramatically improved, usually to the point that they no longer consider their incontinence a significant problem.

The most important thing you can do to improve you bladder symptoms is to speak to a physician about the problem.