What causes stress urinary incontinence (SUI)?

Audrey K. Chun, MD
Geriatric Medicine
The most common types of urinary incontinence are urge incontinence, overflow incontinence, stress incontinence and functional incontinence.

In stress incontinence, most commonly seen in older women (especially those who have had multiple pregnancies), the sphincter muscles at the neck of the bladder are weakened and they lose control of urine when pressure is exerted on the bladder, usually by a laugh, cough or sneeze.
Jill Rabin
OBGYN (Obstetrics & Gynecology)
Generally when we think about stress and pressure, we are referring to the emotions we feel as a result of life’s daily trials and tribulations. Incontinence, however, is a very real reaction to physical stress and pressure on muscles and tissues in our body.

Having stress incontinence is like having occasional faulty plumbing. Your sphincter muscles and/or pelvic floor muscles are not working effectively and can’t properly control a leak in your bladder. In some cases, this weakness can be so severe that standing or walking, in addition to other activities, can cause frequent trips to the bathroom or voiding accidents.

Stress incontinence is also referred to as:
1. Genuine stress incontinence
2. External sphincter incompetence (ESD)
3. Urethral insufficiency/Intrinsic sphincter deficiency (ISD)
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Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)
Stress incontinence is leaking with a cough, sneeze, or other kind of physical exertion such as heavy lifting. If your pelvic floor (comprised of the muscles that support your reproductive system) is weak, it can't keep your urethra closed during everyday abdominal pressures. This is especially common for women who have given birth. It can range from being a slight nuisance to requiring you to wear pads.
The main symptom of stress urinary incontinence (SUI) is losing urine without your control. It may occur when you:
  • Cough
  • Laugh
  • Sneeze
  • Stand (arise from sitting position)
  • Exercise
  • Have sexual intercourse
  • Begin physical activity (for example, lifting objects)
Johns Hopkins Medicine
Administration
Stress incontinence is primarily due to weakness of the valve mechanism (sphincter) in the bladder outlet and urethra. This may be due to intrinsic changes in the urethra, or loss of support and strength of the bladder neck and adjacent structures. It is also associated with post surgical or radiation changes in men following treatment for prostate cancer. With physical exertion or activity that increases abdominal pressure, urine is forced through the deficient valve.
Ja-Hong Kim, MD
Urology
Stress incontinence is leakage of urine caused by activity such as coughing, sneezing, laughing or lifting something heavy. Stress incontinence primarily affects women who have delivered a baby vaginally, which can injure the muscles of the support ligaments that keep the urethra and bladder in the right position. When you lose that support system, pressure on the bladder and urethra can cause an opening of the urethra and subsequent leakage. Stress incontinence can also affect men, primarily those who have had prostate surgery. The prostate provides a mechanism for extra continence; therefore, if your prostate is removed, you are at increased risk for stress-related urinary incontinence. 
Kevin W. Windom, MD
OBGYN (Obstetrics & Gynecology)
Stress urinary incontinence (SUI) is the involuntary loss of urine with coughing, sneezing, laughing, or exercise. It is caused by a weakness in the structural support of the urethra causing it to be hypermobile. The most common causes of SUI are obstetrics trauma from a vaginal birth, chronic cough (smoking), obesity, or a genetic predisposition to weak connective tissue. SUI is seen more frequently in Caucasian women.
Stress urinary incontinence is the unintentional loss of urine during periods of bladder pressure such as coughing, sneezing, lifting, or exercising without an urge to urinate. It occurs as the result of loss of support tissue below the urethra. This can occur after vaginal delivery. 

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Stress Urinary Incontinence is likely caused by child bearing or surgery itself. In this video, I will talk who commonly gets it and why.
Stress incontinence occurs when the urethral sphincter or pelvic floor muscles have been weakened or damaged and cannot dependably hold in urine. Stress incontinence is divided into two subtypes. In urethral hypermobility, the bladder and urethra shift downward when abdominal pressure rises, and there is no hammock-like support for the urethra to be compressed against to keep it closed. In intrinsic sphincter deficiency, problems in the urinary sphincter interfere with full closure or allow the sphincter to open under pressure. Many experts believe that women who have delivered vaginally are most likely to develop stress incontinence because giving birth has stretched and possibly damaged the pelvic floor muscles, connective tissue and nerves. Generally, the larger the baby, the longer the labor, the older the mother, and the greater the number of births, the more likely that incontinence will result.

Ageing is likewise a factor in stress incontinence. As a woman gets older, the muscles in her pelvic floor and urethra weaken, and it takes less pressure for the urethra to open and allow leakage. Estrogen can also play some role, although it is not clear how much. Many women do not experience symptoms until after menopause.

In men, the most frequent cause of stress incontinence is urinary sphincter damage sustained through prostate surgery or a pelvic fracture.

Lung conditions that cause frequent coughing can also contribute to stress incontinence in both men and women. Examples include emphysema and cystic fibrosis.
Intermountain Healthcare
Administration
Stress incontinence is caused by weakness in the muscles and tissues that surround the bladder and urethra. The weakness prevents the urethra from closing completely, so urine leaks out.

Risk factors for stress incontinence include anything that can lead to muscle and tissue weakness around the pelvic organs. For example, a prolapse -- when the bladder, urethra, or other pelvic organ bulges or sinks down out of its normal position -- is sometimes an underlying cause. Childbirth, menopause, excess weight, increasing age, and smoking are other causes.

Stress urinary incontinence can be caused by a variety of factors. In some cases, it may be as minor as putting too much pressure on your bladder, which can be caused by exercising, laughing, sneezing, or coughing. Carrying and birthing a child - as well as menopause - are common causes for SUI in women. For men, a prostate gland removal may cause SUI.

Continue Learning about Urinary Incontinence

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.