Pelvic Prime's Anatomy Academy Series

Stress Incontinence: How Common is it?

Prevalence for Stress Urinary Incontinence

Knowing how common a condition is helps us plan for the needs of a population. Many studies on urinary incontinence in women have shown varying results because of different definitions and study methods. Two important studies in Europe and the United States defined urinary incontinence as any leakage in the past 30 days. 


However, many women with symptoms don't seek treatment, so the actual number may be higher.

Risk Factors for Stress Urinary Incontinence

Causes of Stress Urinary Incontinence

Stress urinary incontinence happens when bladder pressure exceeds urethral pressure. Normally, this doesn't occur because the bladder and urethra adapt to pressure changes. The external urinary sphincter is crucial in maintaining urinary control and any weakness leads to incontinence.  


Weak support structures for the urethra can also lead to incontinence. These include damage to the pubourethral ligament, lateral supports, endopelvic fascia, and pelvic floor muscles. 

Mixed Urinary Incontinence

Mixed urinary incontinence is harder to understand and involves both overactive bladder and sphincter defects. It's challenging to distinguish between stress and urgency incontinence because symptoms are based on patient responses. Pelvic floor muscle training can help with all types of incontinence, and many patients see improvement after stress incontinence surgery. 

Bladder neck mobility is a significant cause of incontinence and can be corrected by surgery, but the exact mechanism behind sphincter weakness remains unknown. 

Lifestyle Choices Associated with Urinary Incontinence

Studies have shown that symptoms like frequent urination, urgency, and incontinence can be linked to certain lifestyle choices, which are changeable. Healthcare professionals can use this information to help patients by recommending changes in behavior to lessen these symptoms. Common factors include obesity, physical activity, smoking, and diet.

Keep in mind that while some lifestyle changes might help, there is not enough strong evidence to make specific recommendations for most cases.

Obesity

Increased body weight, especially around the waist, can increase pressure on the bladder and pelvic floor. Studies show that losing weight can help reduce symptoms of urinary incontinence, especially for women who are overweight or obese. A review found that moderate weight loss should be considered a first-line treatment for incontinence in women.

Physical Activity

Regular physical activity is important for overall health. However, some high-impact activities might increase abdominal pressure and worsen pelvic floor dysfunction. Studies suggest that moderate exercise can reduce the risk of incontinence, but more research is needed to fully understand the effects of different types of physical activity.

Smoking

Smoking is linked to chronic coughing, which increases abdominal pressure and can lead to incontinence. Nicotine can also affect bladder function. While there is evidence that smoking can worsen incontinence, no studies have shown that quitting smoking improves incontinence symptoms. More research is needed.

Diet and Fluid Intake

Certain dietary factors, like caffeine and fluid intake, can influence incontinence symptoms. Reducing caffeine intake has been shown to decrease symptoms like urgency and frequency. Fluid intake should be balanced; too much or too little can cause problems. High fluid intake isn't linked to increased incontinence risk, but reducing excessive intake might help.

Encouraging Lifestyle Changes in Clinical Practice

There are various models and theories to help people adopt healthy behaviors and understand how behavior changes happen. A theory is a set of ideas that explain how something works and can guide actions. Just knowing about a health problem usually isn't enough to make people change their habits. Many healthcare workers think that telling patients about their health issues will motivate them to change, but this isn’t true.

For example, if knowing the dangers of smoking were enough, very few people would still smoke. The same goes for problems related to high BMI. People receive a lot of health information, which they understand based on their experiences, beliefs, and values. Human behavior is complex, so encouraging people to change their habits is also complicated.


Various theories from fields like sociology, psychology, management, and marketing help understand and promote health behavior changes. These models guide the creation of plans to encourage healthy habits. For example, for bladder health, patients might be advised to reduce caffeine, exercise more, and watch their waist size. However, simply telling someone to lose weight usually doesn’t work without behavior change strategies. 

Motivational interviewing is a good way to help patients change their behavior. Originally used for substance abuse, it’s now adapted for other lifestyle changes and has shown to be effective in areas like diet, exercise, diabetes, and smoking. Motivational interviewing focuses on the patient’s readiness to change, understanding that their decision can vary over time. Patients are more likely to accept advice when they are ready. This approach builds rapport, explores the patient’s view on behavior change, and boosts their confidence.  Motivational interviewing uses skills like active listening and empathy, with a mix of open and closed questions. This method makes discussions about behavior change less confrontational and more effective. However, it requires proper training and ongoing practice for healthcare professionals to use it effectively. 

Physical Therapist Clinical Recommendations: Interviewing techniques in promoting continence


These steps help patients become active participants in changing their health behaviors. It’s important for specialized healthcare providers to know when to refer patients to other experts, like dietitians for weight loss.

References: Bo, K., Berghmans, B., Mørkved, S., & Van Kampen, M. (Eds.). (2023). Evidence-Based Physical Therapy for the Pelvic Floor (3rd ed.). Elsevier.