Stress Incontinence

Diagnosis

During your visit, the healthcare professional seeks clues to the cause of your symptoms by using a combination of history, exams and tests. Your appointment typically includes a voiding diary to track fluid intake and urination frequency, a medical history review, and a physical exam — which may include a pelvic exam in women or a rectal exam. A urine sample is often tested for infection or traces of blood. A brief neurological exam may assess how pelvic nerves are working. A urinary stress test may be done, where the provider checks for urine leakage when you cough or bear down with a full bladder.

If more information is needed, bladder function tests may be ordered, such as:

• Measuring how much urine remains in the bladder after you urinate, often checked with an ultrasound or, if needed, a catheter to drain and measure leftover urine.

• Urodynamics: measuring bladder pressures during filling and emptying to assess sphincter function and muscle strength. This may include a pressure-flow study where the bladder is filled slowly with warm fluid and you may be asked to cough or strain to check for leaks.

• Cystoscopy: inserting a scope into the bladder and urethra to look for abnormalities that might explain symptoms.

Common cases of urinary incontinence do not always require these advanced tests, but they are useful when diagnosis is unclear or symptoms persist.

Treatment

Treatment often involves a combination of methods tailored to your situation. If you have a urinary tract infection, that will be treated before focusing on stress incontinence.

Behavioral and lifestyle therapies may include:

• Pelvic floor muscle exercises (Kegel exercises), sometimes guided by a physical therapist, to strengthen the pelvic floor and urinary sphincter.

• Biofeedback used along with exercises to improve effectiveness, helping you learn proper muscle contraction and timing before activities that may cause leakage.

• Adjustments to fluid intake — your provider may advise when and how much to drink during the day while avoiding dehydration.

• Healthy lifestyle changes such as weight loss, quitting smoking, or treating a chronic cough to reduce stress incontinence risk.

• Bladder training: setting a schedule for bathroom visits, particularly useful if urge incontinence is also present.

For females, devices may be offered:

• Vaginal pessaries that support the urethra to prevent leakage during activity. These must be cleaned or replaced regularly.

• Disposable vaginal inserts (similar to tampons) that support the urethra and may be used without prescription, useful for those who want to avoid surgery.

If non-surgical measures are insufficient, surgery may be considered. Options for people assigned female at birth include:

• Midurethral sling procedure, placing a small mesh under the urethra for support.

• Bladder neck sling procedure, using tissue from the abdomen or thigh to support the bladder neck when prior surgery has failed.

• Injection of bulking agents around the urethra to improve closure.

• Retropubic colposuspension, using stitches to lift and support tissues near the bladder neck and urethra; can be done by minimally invasive or open surgery.

For people assigned male at birth, surgical options can include:

• Injection of bulking agents around the upper urethra to bulk tissues and improve closure.

• Placement of an inflatable artificial sphincter. A cuff encircles the urethra, connected to a balloon in the pelvis and a pump in the scrotum that you control manually. Over time, additional surgery may be needed to maintain function.

If you like, I can also add a section for “Prevention” or “When to See a Doctor” for urinary incontinence in the same format.