Incontinence

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Risk Factors for Stress Incontinence

Risk factors include childbirth, menopause, and pelvic surgery (e.g., prostatectomy, hysterectomy).

Childbirth
Pregnancy and childbirth can flatten, stretch, and weaken the pelvic floor muscles that support the bladder neck and urethra. The position of the bladder and urethra may change, bladder control nerves may be damaged, or an episiotomy (incision of the perineum and vagina) may be performed to prevent tearing during vaginal delivery. These complications will weaken the pelvic floor muscles.

If bladder control is lost immediately after childbirth, the pelvic floor muscles may recover within 6 weeks. If continence is not regained, treatment may be required. Sometimes incontinence develops months or years after childbirth. Women who exercise the pelvic floor muscles (Kegel exercises) are less likely to develop incontinence.

Menopause
At menopause, the ovaries stop producing estrogen. Lack of estrogen results in thinned tissues that line the urethra, a weakened sphincter mechanism that opens and closes the urethra, and weak bladder muscles. These factors can cause the urethral sphincter to open during physical activity.

Pelvic surgery
Pelvic surgery can weaken and damage the pelvic floor muscles, causing the bladder neck and urethra to drop when abdominal pressure is applied (hypermobility) during physical activity.

Surgical procedures that may affect the pelvic floor muscles include the following:

• Abdominal resection for colorectal cancer
• Complete or partial hysterectomy (removal of the uterus)
• Failed surgery to correct stress incontinence

Causes

Stress incontinence is caused by the following:

• Thinning of the urethral lining
• Vaginal prolapse (e.g., cystocele, enterocele, rectocele, uterine prolapse, vaginal vault prolapse)
• Weakened bladder and/or pelvic floor muscles
• Weakened urethral sphincter

Signs and Symptoms
Urine leaks during strenuous physical activity.

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Overview
Risk Factors
Causes
Management
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