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JAMA Patient Page
July 16, 2003

Stress Incontinence

JAMA. 2003;290(3):426. doi:10.1001/jama.290.3.426

Urinary incontinence is any unintentional leakage of urine. It can be caused by several underlying medical conditions, including urinary infections, strokes, pregnancy, obesity, neurological problems, and other health problems sometimes associated with aging. Stress incontinence is a type of urinary incontinence. A person with stress incontinence is unable to hold urine while coughing, sneezing, or laughing or during other movements that put pressure on the bladder, the organ that collects and holds urine. Fortunately, stress incontinence can usually be successfully treated.

The July 16, 2003, issue of JAMA includes an article about stress incontinence.


When you urinate, the muscles of the bladder tighten and squeeze the urine out through the urethra, a tube that leads from the bladder to the outside of your body. At the same time, muscles surrounding the urethra loosen, allowing the urine to pass through. These muscles can also tighten and squeeze the urethra shut to prevent urine from passing. If these muscles become weak or damaged, they may not be able to hold urine during activities such as sneezing or laughing. The resulting urine leakage may be just a small amount, or if the bladder is full, it may be more.

Tests for stress incontinence

  • Urinalysis—testing urine for evidence of infection and other abnormalities

  • Ultrasound—using sound waves to measure the amount of urine remaining in the bladder after urination

  • Urodynamics—testing the function of the bladder by filling it with water through a catheter (a tube placed through the urethra into the bladder)

Possible treatments for stress incontinence

  • Kegel exercises are designed to strengthen the pelvic floor muscles that support the bladder and the muscles that surround the urethra

  • Behavioral treatment involves learning how to gain better control over the muscles involved in urination and incontinence and may include charts or diaries to track urination schedules and episodes of incontinence.

  • Biofeedback is designed to increase awareness of muscle tension using electrical or pressure sensing devices.

  • Pelvic floor electrical stimulation uses short pulses of electrical stimulation to strengthen the pelvic floor muscles.

  • Collagen injections in the tissues around the urethra can be done to improve holding in urine.

  • Surgery may improve the support of the bladder and urethra. If you think your are experiencing stress incontinence, see your doctor for an evaluation and consideration of the best treatment for your particular symptoms.

If you think your are experiencing stress incontinence, see your doctor for an evaluation and consideration of the best treatment for your particular symptoms.

For more information

American College of Obstetricians and Gynecologists

National Institute of Diabetes & Digestive & Kidney Disease National Kidney and Urologic Diseases Information Clearinghouse

Inform yourself

To find this and other JAMA Patient Pages, go to the Patient Page link on JAMA ’s Web site at www.jama.com. A Patient Page on urinary incontinence was published in the December 16, 1998, issue.

The JAMA Patient Page is a public service of JAMA . The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424.

Sources: American College of Obstetricians and Gynecologists, National Institute of Diabetes & Digestive & Kidney Disease, American Foundation for Urologic Disease, American Urogynecologic Society, American Urological Association.

Topic: Incontinence