Stress incontinence and urge incontinence are the most common types of urinary incontinence. So, what is the difference between them both?
According to the National Association for Continence, “Stress incontinence causes the bladder to leak during exercise, coughing, laughing or any body movement that puts pressure on the bladder”. Urge incontinence, on the other hand, is defined as “sudden involuntary contraction of the muscular wall of the bladder causing urinary urgency, an immediate unstoppable urge to urinate”. Understanding the key differences between them both, however, requires an understanding of the different causes and symptoms.
Urge incontinence vs Stress Incontinence
Stress incontinence is present when the urethral sphincter or pelvic floor muscles are weakened. “Stress” refers to the physical strain associated with leakage. Contrary to the name, stress incontinence does not actually have anything to do with emotional stress, although stress can worsen the condition. You can read about psychological stress and incontinence here. If you leak when you jump, laugh or cough, you have stress incontinence. Physical exertion that increases abdominal pressure also puts pressure on the bladder. This presence of physical exertion is vital to consider when differentiating stress incontinence from urge incontinence. Individuals with stress incontinence may leak when they run on a treadmill, lift something heavy, or laugh. Speed skater Bonnie Blair and her Doctor, urogynecologist Dennis P. Miller, MD, have been open in discussing Bonnie’s experience with stress incontinence. Short after the birth of her first child, he discovered her problem. While on a run, she remembers suddenly experiencing leakage. She claims, “it wasn’t just exercise, it happened if I coughed or leant down to get something from the refrigerator”. She recalls finally having the guts to talk about it, asserting “I went almost a year before I even said anything to my husband. I was finally diagnosed with stress incontinence, which is more common than you realise. Go to your Doctor and be honest and open about what you’re experiencing”.
Stress Incontinence is often caused by:
-Childbirth and Pregnancy. The muscles in the bladder sphincter and pelvic floor can become overwhelmed by extra stress placed on the bladder from a baby. Hormones can also play a part in this. When you give birth to your baby, your pelvic floor muscles are stretched even more. Read more about pregnancy and childbirth.
-Prostate Surgery. Damage can often be done to the urethra during prostate surgery. It can often damage the nerves that control urination.
-Obesity. People who are overweight have a higher risk of stress incontinence, as more pressure is placed on the pelvic floor.
-Smoking, which can cause you to develop a chronic cough
-High impact activities over many years. Your pelvic floor muscles can become weakened if you have many years of weight lifting or strenuous activity behind you. This is often known as athletic incontinence.
To understand the other main difference between the conditions, we can look for a clue in the phrase “urge incontinence”. Individuals with urge incontinence have a strong urge to urinate before leaking, which is unpreventable. It is often referred to as an “unstable bladder” or “detrusor instability”. Urge incontinence is associated with a great urgency or desire to urinate, which cannot be suppressed. It can kick in when you get close to a toilet and suddenly find you can’t make it all the way. Accidental urination in urge incontinence can even be triggered by a sudden change in position or activity, hearing running water or drinking liquid. Caroline, aged 25, explains how she experienced incontinence in her 20s. She explains, “An urge to go to the toilet would come and I wouldn’t be able to hold on. I would wet myself and it wasn’t only a little. I would become drenched”. After bladder retraining would not work, she was diagnosed with Multiple Sclerosis. This meant she was unable to control her nerves and prevent unwanted leakages. After bladder augmentation surgery, she explains how she was completely dry after the procedure.
Urge incontinence is often caused by injuries to the nervous system, as in Caroline’s case. Other causes of urge incontinence are the following:
-A bladder infection. Infections can irritate your bladder, causing you to have strong urges to urinate.
-Bladder cancer. Bladder cancer can cause you to pass urine very urgently as a complication of a tumour on the bladder. Cancer surgery can cut peripheral nerves that help control bladder function.
-Trauma to the spinal cord. The spine is part of the central nervous system, so severe damage can impact bladder function.
-A stroke. A stroke can affect the communication between the brain and bladder.
-Inflammation. Inflammation of the bladder can alter bladder function and cause unwanted urges.