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# Stress urinary incontinence

Stress urinary incontinence is leaking urine when coughing, sneezing, laughing or lifting, because the urethra cannot stay closed against the pressure.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Urethra (female)](https://durgical.com/en/anatomy/female-urethra/)
- [External urethral sphincter](https://durgical.com/en/anatomy/female-external-urethral-sphincter/)
- [Urinary bladder](https://durgical.com/en/anatomy/urinary-bladder/)
- [Pubococcygeus](https://durgical.com/en/anatomy/pubococcygeus-muscle/)
- [Perineal membrane](https://durgical.com/en/anatomy/perineal-membrane/)
- [Trigone of bladder](https://durgical.com/en/anatomy/trigone-of-bladder/)
- [Pudendal nerve](https://durgical.com/en/anatomy/pudendal-nerve/)

## In physiology

- [Micturition and the bladder reflex](https://durgical.com/en/physiology/micturition-and-the-bladder-reflex/)

## What it is

Involuntary leakage of urine on effort or exertion, such as coughing, sneezing, laughing, lifting or exercise, because the urethral closure mechanism cannot resist the rise in abdominal pressure.

## Who gets it

The most common type of urinary incontinence in women, especially after childbirth and in midlife; it is under-reported because of embarrassment. In men it occurs mainly after [prostate](https://durgical.com/en/anatomy/prostate/) surgery.

## Causes

- Urethral hypermobility from weak pelvic floor muscles and loss of the fascial support under the urethra
- Intrinsic sphincter deficiency: a weak urethral sphincter and mucosal seal
- In men: sphincter injury after radical prostatectomy or other prostate surgery

## Risk factors

- Pregnancy and vaginal childbirth, especially instrumental delivery
- Obesity
- Increasing age and menopause
- Chronic cough, constipation and heavy lifting
- High-impact sport
- Pelvic surgery or radiotherapy
- Smoking

## Pathophysiology

Continence depends on urethral closure pressure staying higher than bladder pressure. The urethra normally rests on a hammock of pubocervical fascia and levator ani that closes it on coughing. Without that support it descends and opens under pressure (hypermobility); a weak sphincter leaks even without descent. The detrusor is not overactive in pure stress incontinence.

## Classification

- Pure stress urinary incontinence
- Mixed urinary incontinence: stress plus urgency incontinence
- By mechanism: urethral hypermobility or intrinsic sphincter deficiency
- By severity: frequency and volume of leaks and impact on daily life

## Symptoms and signs

- Small spurts of urine leaking with coughing, sneezing, laughing, lifting, running or jumping
- Leak happens at the moment of effort, not after a sudden urge
- Usually no leakage at night while lying down
- Use of pads and avoidance of exercise or social activities

## Red flags

- Haematuria (exclude bladder cancer or stones)
- Continuous leakage day and night (consider a fistula)
- Urinary retention or a palpable bladder
- Recurrent urinary tract infections
- New neurological symptoms (back pain, leg weakness, saddle numbness)
- Pelvic mass or significant prolapse

## Diagnosis

**Clinical**
History of leakage with effort; a bladder diary over a few days; pelvic examination with a cough stress test, assessment of prolapse and of [pelvic floor](https://durgical.com/en/anatomy/levator-ani/) contraction.

**Tests**
Urinalysis for infection or blood; post-void residual volume; pad test in some services; urodynamic studies when the picture is unclear, mixed, or before surgery (practice varies between guidelines).

**Imaging**
Usually not needed. Ultrasound measures residual urine; imaging is kept for suspected structural problems or complications of previous surgery.

## Differential diagnosis

- Urgency urinary incontinence (overactive bladder)
- Overflow incontinence from retention
- Urinary tract infection
- Vesicovaginal or ureterovaginal fistula
- Urethral diverticulum
- Functional incontinence from limited mobility or cognition

## Goal of treatment

Reduce or stop leakage and improve quality of life, starting with conservative measures and moving to surgery when these are not enough.

## Treatment

**Lifestyle**
Weight loss in women with obesity, adjusting fluid and caffeine intake, stopping smoking and treating constipation and cough.

**Rehabilitation**
Supervised pelvic floor muscle training for at least about three months is the first-line treatment; biofeedback and bladder training may be added.

**Conservative**
Vaginal devices such as continence pessaries, or urethral inserts, for selected women.

**Medical**
Vaginal oestrogen in postmenopausal women with atrophy; some guidelines allow a serotonin–noradrenaline reuptake inhibitor when surgery is not wanted.

**Procedure**
Urethral bulking agents injected around the urethra, a less invasive option with lower long-term success.

**Surgical**
Midurethral sling (retropubic or transobturator tape), colposuspension (Burch) or an autologous fascial sling; in men after prostatectomy, a male sling or artificial urinary sphincter.

## Complications

- [Skin](https://durgical.com/en/anatomy/skin/) irritation and infection from wetness
- Social isolation, reduced physical activity and depression
- Sexual dysfunction
- After surgery: voiding difficulty, new urgency, bladder or bowel injury, tape exposure or chronic pain

## Prognosis

Pelvic floor training cures or improves many women, and surgery gives high success rates; symptoms can return over time, so long-term follow-up is useful.

## Prevention

- Pelvic floor muscle training during and after pregnancy
- Healthy weight
- Avoiding chronic straining and smoking

## Test yourself

Think of the answer, then tap the question to see it.

## What distinguishes stress from urgency urinary incontinence?

Stress leakage occurs at the moment of effort (cough, sneeze, lifting); urgency leakage follows a sudden strong need to void from detrusor overactivity.

## What are the two mechanisms of stress urinary incontinence?

Urethral hypermobility from loss of support, and intrinsic sphincter deficiency.

## What is the first-line treatment for stress urinary incontinence in women?

Supervised pelvic floor muscle training for at least about three months, with lifestyle measures such as weight loss.

## Which operation is most often used for female stress urinary incontinence?

The midurethral sling (retropubic or transobturator tape); colposuspension and fascial slings are alternatives.

## Which simple bedside test reproduces stress incontinence?

The cough stress test: leakage from the urethra seen at the moment of a cough with a full bladder.

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## Related conditions

- [Pelvic organ prolapse](https://durgical.com/en/conditions/pelvic-organ-prolapse/)
- [Urinary tract infection (acute cystitis)](https://durgical.com/en/conditions/urinary-tract-infection/)
- [Obstetric perineal tears and anal sphincter injury](https://durgical.com/en/conditions/obstetric-perineal-tears-and-anal-sphincter-injury/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Stress Urinary Incontinence](https://www.ncbi.nlm.nih.gov/books/NBK539769/) (StatPearls (NCBI Bookshelf), 2024).

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Source: https://durgical.com/en/conditions/stress-urinary-incontinence/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/stress-urinary-incontinence/