What is external sphincter insufficiency (ESD)?

Jill Rabin
OBGYN (Obstetrics & Gynecology)

External sphincter insufficiency (ESD), the most common of the two types of stress incontinence, causes urine leakage when the abdominal muscles tighten (during coughing, laughing, sneezing), thus creating abdominal pressure against the bladder and urethra. A well-supported urethra will not leak.

For someone with stress incontinence, however, the pelvic floor muscles and the connective tissue that supports the bladder and urethra are so worn that when the stress of a cough occurs, bladder pressure (from the stress pressure in the abdomen) exceeds pressure in the urethra (pushed down and out of the abdominal compartment) and causes leakage.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.