Published on 26th April 2023

Do you often find yourself struggling to hold your pee during fits of uncontrollable laughter? Perhaps you can't cough or sneeze without a little bit of urine escaping without warning? Maybe every time you exert yourself physically — whether lifting weights or simply picking up your kids for a cuddle — you’re worried about dampness down below?

If any (or all) of these apply to you, you could be suffering from something called stress incontinence. It’s very common — especially in women — and usually nothing to worry about, and the good news is there are simple exercises that can reduce urine leaks.

There are a number of ways to treat stress incontinence and take back control of your bladder. First, let’s explore exactly what stress incontinence is, what causes it, and how to know whether you have it, before discussing how to treat stress incontinence

What is stress incontinence?

Stress incontinence (sometimes called stress urinary incontinence or SUI) is a common type of urinary incontinence in which you leak urine involuntarily when extra pressure is put on the bladder, usually due to some kind of physical exertion. If you’re suffering from stress incontinence, you’ll often find small amounts of urine leaking unexpectedly due to factors such as:

  • Sneezing

  • Coughing

  • Laughing

  • Exercising (such as aerobic exercise or weight training)

  • Heavy lifting

There are many types of urinary incontinence, with stress incontinence being the most common, particularly among women. Many people who have stress incontinence also suffer from urge incontinence (having an unstoppable urge to pee). This is known as mixed incontinence, and is thought to affect more than half of stress incontinence sufferers. 

How common is stress incontinence?

Stress incontinence is especially common in women — particularly those who have gone through childbirth or the menopause — with around 1 in 3 experiencing it at some point in their lives. It’s even more prevalent in older women, with around half of women aged 65 and older finding that they at least sometimes leak urine due to SUI. Over half of women with SUI also have an overactive bladder (OAB), which is characterized by a sudden, uncontrollable urge to pee.

What causes stress incontinence?

Stress incontinence is triggered by sudden pressure on the bladder and urethra (the small tube through which urine leaves the body), causing the sphincter muscle to open involuntarily and urine to leak out. This pressure can be the result of any kind of physical activity or bodily exertion. 

There are a number of factors that can increase your risk of experiencing stress incontinence. These risk factors include:

  • Age (the risk increases as you get older)

  • Pregnancy and childbirth (especially vaginal birth)

  • Menopause (usually experienced by women aged 45 and older)

  • Obesity

  • Diabetes

  • Pelvic surgery (a hysterectomy, for example)

  • Pelvis or lower back injuries

  • Chronic coughing

  • Uterine prolapse (where the muscles around the uterus weaken)

What are the main symptoms of stress incontinence?

You’ll know that you’re suffering from stress incontinence if you frequently leak urine when pressure is put on the bladder through some form of physical exertion, such as exercise, heavy lifting, sneezing, coughing, or laughing. However, the symptoms may present slightly differently depending on whether you have mild or moderate to severe stress incontinence:

  • With mild stress incontinence, you’re likely to leak small amounts of urine (i.e. a few small drops) when the bladder is put under pressure through physical exertion.

  • With moderate to severe stress incontinence, you may experience more significant urine leakage (more than a tablespoon at a time, for instance) even when doing less strenuous activities such as bending over. You may also leak urine during sex.

What is the most effective treatment for stress incontinence?

Typically, the most effective way to prevent and treat stress incontinence is to perform pelvic floor exercises (also known as Kegels) to strengthen the pelvic floor muscles. This is often the first-line recommended treatment for stress incontinence, with one study finding pelvic floor muscle training to be at least 62% effective at significantly reducing urinary incontinence. 

How to perform stress incontinence exercises

To perform Kegel exercises to help with stress incontinence symptoms, you first need to locate your pelvic floor. You can do this by imagining you’re stopping your urine in mid-flow (or alternatively doing it when you’re actually going to the bathroom); the muscles you ‘squeeze’ when holding your urine are the same muscles you’ll contract when doing Kegels.

If you’re struggling to locate your pelvic floor muscles — or you’re just not sure how to contract them properly — the Elvie Trainer has been designed precisely for this situation. This smart little workout assistant helps you visualize your pelvic floor muscles using biofeedback, guiding you through each contraction to ensure you’ve got the technique right. 

Once you’ve successfully located your pelvic floor muscles and perfected your contraction technique, simply follow these steps to perform Kegel exercises effectively:

  1. Start by lying on your back (you can do Kegels in a seated or standing position, but this is easiest when you’re just getting started).

  2. Contract (squeeze) your pelvic floor muscles for 3 to 5 seconds (keeping your abdominals and buttocks relaxed).

  3. Relax the pelvic floor muscles for 3 to 5 seconds.

  4. Repeat this cycle (contract, relax, contract, relax) 10 times.

  5. Perform 3 sets of 10 Kegels each day, leaving a few hours between sets.

  6. Once you feel more confident, you can increase your contractions to 10 seconds each time.  

One study also found that women with stress urinary incontinence benefited more from pelvic floor muscle training alongside abdominal training than through pelvic floor exercises alone. While you want to avoid intense ab workouts if you have a weak pelvic floor, strengthening your core through pelvic floor-friendly abdominal exercises can help to reduce involuntary urine leakage.

What other treatments are there for stress incontinence?

If you’ve tried Kegel exercises and they haven’t worked as effectively as you’d hoped — or if you simply want to explore a secondary or backup treatment option — there are a few alternative stress incontinence treatments to explore. These include: 

  • Bladder training. If you have mixed incontinence (a combination of stress and urge incontinence), you may be able to reduce leakage by ‘training’ the bladder; for example, by going to the bathroom at scheduled intervals (whether you feel the urge or not) or delaying urination when you feel the urge to go.

  • Vaginal pessaries. A small, removable device usually made of silicone, a vaginal pessary is inserted into the vagina and is typically involved in the treatment of pelvic organ prolapse (POP). However, a pessary may also help to reduce stress incontinence symptoms. 

  • Surgical procedures. If none of the aforementioned treatment methods for stress incontinence have worked, surgery might be an option, though this of course will be a last resort. This may involve inserting a ‘sling’ to support the urethra.

How can I stop stress incontinence?

While pelvic floor training is typically the most effective way to prevent stress incontinence, several lifestyle factors can increase the likelihood of you experiencing the condition, and therefore making some fairly simple lifestyle changes can help prevent it. These include:

  • Losing weight. Being overweight can place extra pressure on the bladder and increase the likelihood of stress incontinence, so losing weight by switching to a healthy diet and lifestyle can help to reduce and prevent leaks.

  • Quitting smoking. Smokers are shown to have an increased prevalence of incontinence symptoms; if you smoke, kicking the habit can help to reduce the likelihood of you experiencing urine leaks. 

  • Avoiding bladder irritants. Certain foods and drinks, including tea, coffee, sodas, and chocolate, can irritate the bladder and exacerbate incontinence symptoms. Cutting down on these may help to reduce the risk of stress incontinence.

  • Eating a fiber-rich diet. Chronic constipation can provoke or intensify incontinence. Adding more fiber into your diet through high-fiber foods such as whole grains, fruits and vegetables can relieve constipation and may help to improve bladder control. 

  • Cutting down on alcohol. Alcohol is a diuretic which has a dehydrating effect on the body and can cause you to pee more often. This may fan the flames of incontinence, so cutting down can help to reduce the likelihood of urine leakage. 

While stress incontinence is remarkably common and very rarely anything to worry about, that doesn’t stop it being decidedly unwelcome, inconvenient, and potentially a little embarrassing. But with a number of effective remedies available, the fear of leaking urine when you laugh, sneeze, or work out shouldn’t knock your confidence or stop you living your life to the full.