Therapy Services

Stress incontinence in women

This booklet will provide you with information about stress incontinence and its treatment with pelvic floor muscle exercises.


What is stress incontinence?Show [+]Hide [-]

Stress incontinence is when urine leaks from the bladder due to a sudden extra pressure such as during coughing or sneezing. This is because your pelvic floor muscles and urethra cannot withstand the extra pressure. Stress incontinence often develops because the pelvic floor muscles are weakened. The amount of urine leaked can vary from small amounts but sometimes it can be quite a lot and can cause embarrassment. Urine tends to leak most when you cough, laugh, bending over or when you exercise.

How common is stress incontinence?

Stress incontinence is the most common form of urinary incontinence. Stress incontinence becomes more common in older women and as many as one in five women over the age of 40 have some degree of stress incontinence.

Causes of muscle weakness

  • Childbirth is the most common reason why women develop stress incontinence; a vaginal delivery can cause trauma to the pelvic floor muscles or the nerves to the muscles. This results in muscle weakness and a lack of support to the bladder.
  • Lack of exercise
  • Changing hormone levels in pregnancy and menopause 
  • Long term history of constipation
  • Chronic cough or chest problems 
  • Being overweight
  • Certain sports, for example, running and jogging
  • Performing abdominal exercises incorrectly
  • Incorrect lifting techniques

Treatment for stress incontinenceShow [+]Hide [-]

Research suggests that pelvic floor muscle exercises are often an effective treatment for stress incontinence. These exercises are appropriate for all women except those who have had pelvic floor surgery in the past six weeks.

Where are the pelvic floor muscles?

The pelvic floor muscles are the firm supportive muscles that stretch from your pubic bone at the front of your pelvis to the base of your spine at the back. The pelvic floor muscles help to hold your bladder, womb and bowel in place, and to close your bladder outlet and back passage.

Stress incontinence diagram

When your pelvic floor muscles are well toned they stop leakage of urine from your bladder and wind or faeces from the bowel.

When you pass urine or stools the pelvic floor muscles relax, when empty they tighten to restore control. These muscles actively squeeze when you laugh or cough to avoid leaking.

How do I do pelvic floor exercises?Show [+]Hide [-]

You can choose which position you would like to do your exercises. Either lie down with your knees bent and feet on the bed; sit comfortably upright with your feet touching the floor or standing up.

It is not always easy to find your pelvic floor muscles. Exercising them should not show at all ‘on the outside’. It is important that you should not pull in your tummy, tighten your buttocks excessively, nor hold your breath.

There are two types of pelvic floor exercises, slow (endurance) and fast.

Slow exercise

  • Tighten and pull up the muscle firstly around your anus and secondly your vagina. This squeezes the muscle upwards and forwards. Imagine that you are trying to stop yourself from passing wind, and at the same time stopping your flow of urine.
  • Hold tight for as long as you can, (up to ten seconds).
  • Rest for four seconds
  • Repeat the exercise, up to ten times

Fast exercise 

  • Tighten your pelvic floor muscles as before, as quickly as you can, hold the contraction for one second before relaxing.
  • Repeat this exercise up to ten times.
  • Use this exercise to tighten your pelvic floor muscles before you cough, sneeze, bend over or exercise to prevent leakage

Repeat both of these exercises four times per day for six months.

This will enable your pelvic floor to work more effectively and stronger.

TipsShow [+]Hide [-]

Use ‘triggers’ through the day to remind you to do your exercises, for example when boiling the kettle, or while sitting on the bus

  • Tighten the pelvic floor muscles during exercising and before you cough, laugh, sneeze or lift anything heavy, to avoid strain.
  • Drink eight cups of fluid per day.
  • Only go the toilet if your bladder is full. Do not get into the habit of going ‘just in case’.
  • Avoid constipation as straining to empty your bowels may make urinary and bowel symptoms worse
  • Always sit on the toilet and ensure you fully empty your bladder, rocking forward after passing urine.
  • Make getting to the toilet as easy as possible. If you have difficulty getting about, consider special adaptations like a handrail or a raised seat in your toilet.
  • It is known that stress incontinence is more common in women who are obese. Losing weight may help to ease the problem.
  • Smoking and asthma can cause coughing which can aggravate symptoms. It would help not to smoke and to speak to your GP about your cough.

When you are confident that you are doing your pelvic floor exercises correctly you will be able to do them whilst standing, lying or sitting and you can carry out the exercises anytime, anywhere. After six months you can maintain your pelvic floor strength by doing these exercises once a day, for the rest of your life.

If you require incontinence pads to manage your symptoms ask your GP for advice. If you have any problems doing these exercises, or you have continuing symptoms of urinary leakage seek advice from your GP or physiotherapist. There are alternative treatments which may help such as vaginal cones or electrical stimulation. Various surgical operations are used to treat stress incontinence if symptoms persist after completing a course of pelvic floor exercises.

More information

If you require any further help please contact

  • Julie Ellis or Emma Hargreaves, Women’s Health Physiotherapists
  • tel: 0191 282 5484 - 9.00am to 4.30pm, Monday to Friday

Leaflet to download

You can download the information on this page as a PDF leaflet.pdf

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