Stress incontinence is prompted by a physical movement or activity — such as coughing, sneezing or heavy lifting — that puts pressure (stress) on your bladder. Stress incontinence is not related to psychological stress.
Stress incontinence is much more common in women than in men. 
If you have stress incontinence, you may feel embarrassed, isolate yourself or limit your work and social life, especially exercise and leisure activities. With treatment, you'll likely be able to manage stress incontinence and improve your overall well-being.
If you have stress incontinence, you may experience urine leakage when you:
- Cough
- Sneeze
- Laugh
- Stand up
- Lift something heavy
- Exercise
You may not experience incontinence every time you do one of these things, but any pressure-increasing activity can make you more vulnerable to unintentional urine loss, particularly when your bladder is full.
When to see a doctor
Talk to your doctor if the signs and symptoms of stress incontinence interfere with your activities of daily living, such as your work, hobbies and social life.
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
Factors that increase the risk of developing stress incontinence include the following:
Age. Although stress incontinence isn't a normal part of aging, physical changes associated with aging, such as the weakening of muscles, may make you more susceptible to stress incontinence. Also, women in menopause lose the beneficial effects of estrogen — that is, strengthening and protecting the tissues of the vagina and urethra — making the development of stress incontinence more likely.
Type of delivery. Forceps delivery of a baby may be associated with a greater risk of stress incontinence than is normal vaginal delivery. Multiple deliveries also may be associated with a higher risk.
Obesity. People who are obese have a much higher risk of stress incontinence. Excess weight increases pressure on the abdominal organs. Subsequently, the "resting" pressure on the bladder may be increased even without the additional pressure from a cough or other force.
Previous pelvic surgery. Hysterectomy in women, and particularly prostate surgery in men, can alter the function and support of the bladder and urethra, making it much more likely for a person to develop stress incontinence. This effect can be either immediate or delayed.
Complications of stress incontinence may include:
Personal distress. If you experience stress incontinence, you may feel embarrassed and distressed by the condition. It often disrupts work, social activities, interpersonal relationships and sexual relations.
Mixed incontinence. Mixed incontinence usually involves both stress incontinence and urge incontinence — the loss of urine resulting from an involuntary contraction of bladder muscles (overactive bladder).
Skin rash or irritation. Skin that is constantly in contact with urine is likely to be irritated, sore and can break down. This can happen with severe incontinence if you don't take precautions such as using moisture barriers or incontinence pads. However, use of incontinence products can cause further embarrassment and personal distress.
Preparing to see your appointment:
Your doctor may use a questionnaire to make a preliminary assessment of your symptoms. You may also be asked to keep a voiding diary for a few days. You'll record when, how much and what kind of fluids you consume, as well as when you urinate and when you experience incontinence. Your diary may reveal patterns that help your doctor understand symptoms and identify contributing factors.
Specialized testing may require referral to a specialist in urinary disorders (urologist) or urinary disorders in women (urologist or urogynecologist).
What you can do
To get the most from your visit to the doctor, prepare in advance:
Write down any symptoms you're experiencing. Include all of your symptoms, even if you don't think they're related.
Make a list of any medications or vitamin supplements you take, regardless of how common you think they are. Many over-the-counter supplements can irritate the urinary tract. Also write down doses and how often you take the medication.
Have a family member or close friend accompany you, if possible. You may be given a lot of information at your visit, and it can be difficult to remember everything.
Take a notebook or notepad with you. Use it to write down important information during your visit.
Prepare a list of questions to ask your doctor.
List your most important questions first, in case time runs out.
For urinary incontinence, some basic questions to ask your doctor include:
Will my urinary incontinence go away eventually?
What kind of tests might I need to determine the cause of my incontinence?
Will changing my diet help with my incontinence?
How does my weight affect my condition?
Could pelvic floor exercises help me? How do I do them?
Could the medicines I take be aggravating my condition?
Are there any medications that would help with my bladder control?
What additional testing will I need to undergo?
Will I need surgery?
Make sure that you understand everything your doctor tells you. Don't hesitate to ask your doctor to repeat information or to ask follow-up questions for clarification.
What to expect from your doctor
Be prepared to answer questions from your doctor. Potential questions your doctor might ask include:
How often do you leak urine?
When you leak urine, is it a few drops or are your clothes soaked?
Do you leak urine when you laugh, cough, sneeze or lift heavy objects?
Do you leak urine when you exercise?
How often do you urinate in the toilet during the day?
Do you wake up at least twice during the night to urinate?
What's your typical daily fluid intake?
Do you drink beverages with caffeine or alcohol? How many each day?
Does anything seem to make your incontinence better? How about worse?
What's the most bothersome aspect of your problem with urinary incontinence?
Diet and exercise go
