Stress Urinary Incontinence: Leaking When You Cough or Laugh

Ultimo aggiornamento: 15 agosto 2026

• WordPress
• LinkedIn
• Posta

Stress urinary incontinence (SUI) is leakage that happens when pressure inside the abdomen rises — coughing, laughing, sneezing, exercising, lifting something heavy. It affects around 15% of adult women, and the statistic that matters more is the second one: only about 60% of them ever seek treatment.

That gap is the reason for this article. Women stop running, avoid trampolines with their children, plan outings around toilets and carry spare underwear — all for a condition that is common, well understood and treatable. There is nothing shameful in it, and nothing inevitable about it either.

• Centro di urologia Ospedale di Bangkok Thailandia Prenotazione online 02-310-3009 bhquro@bdms.co.th
• Ospedale Samitivej Sriracha Chonburi 088-022-1445

Le 2 cause principali di stress urinary incontinence

1. Pelvic floor dysfunction

The pelvic floor muscles are the hammock that keeps the urethra closed when pressure rises. Anything that weakens or damages them can cause SUI:

• Obesità — the pelvic floor carries the weight of everything above it, and excess abdominal weight increases that load year after year.
• Menopausa — estrogen maintains the blood supply and lining of the urethra; when it falls, the urethra seals less effectively.
• Gravidanza — each pregnancy loads the pelvic floor, and the risk rises with the number of them.
• Vaginal delivery — some pelvic floor trauma is unavoidable as the baby passes through, particularly where there is a perineal tear.
• Tosse cronica e stitichezza — repeated pressure spikes, day after day, wear the pelvic floor down. Both are treatable, which makes them the most modifiable items on this list.

2. Nerve or muscle damage from previous pelvic surgery

Major pelvic surgery can disrupt the continence mechanism directly. In men, radical prostatectomy for prostate cancer is the usual context — worth saying plainly, because SUI is often thought of as a women’s condition and men who develop it afterwards are frequently unprepared for it.

Getting the diagnosis right first

Assessment covers a full history, physical examination and appropriate tests. The important thing it establishes is which kind of incontinence you actually have, because stress incontinence and incontinenza da urgenza are treated completely differently — and many women have both at once.

Where the picture is mixed or the symptoms do not fit neatly, a urodynamic study measures how the bladder and urethra behave during filling and during a rise in pressure, which settles it. Dr. Soarawee performs urodynamic studies at Bangkok Hospital Headquarters.

Treatment, in order

1. Behavioural measures — first line

• Kegel (pelvic floor) exercises — 3 sets of 10 contractions, each held for 10 seconds, three times a day. Two things are worth knowing before you start: improvement takes 6–12 weeks, so early disappointment is normal rather than failure; and a great many women contract the wrong muscles, so having the technique checked by a pelvic floor physiotherapist is time well spent.
• Timed voiding — emptying on a schedule so the bladder is never full when the pressure rises.
• Weight loss and treating a chronic cough or constipation — unglamorous, and they remove the force that is causing the leakage in the first place.
• Pessary — useful where examination shows anatomical prolapse contributing to the problem.

2. Medication — second line

• Duloxetine — increases the closing pressure of the urethral sphincter. Note that it is licensed for stress incontinence in some countries and not others, so availability varies.
• Topical vaginal estrogen — restores the urethral lining after the menopause; the same treatment also reduces recurrent urinary infections in this group.
• Anticholinergics — these do not treat stress incontinence itself. They are used where there is a coexisting overactive bladder component, which is why establishing the type first matters.

3. Surgery — definitive

• Iniezione di agente bulbante uretrale — less invasive, suitable for selected patients, with a shorter recovery.
• Mid-urethral sling (MUS) — the gold standard for female SUI, with high long-term success rates.

Surgery is considered once behavioural measures and medication have been given a fair trial, or where the leakage is severe enough that starting there makes more sense. Neither the mid-urethral sling nor urethral bulking agent injection is performed at Bangkok Hospital Headquarters — if your case reaches that point, a referral to a centre that provides them can be arranged. Everything up to that decision, including the assessment, the urodynamic study and the medical treatment, can be done here.

Se si soffre di incontinenza urinaria da stress e si desidera una valutazione specialistica, la dottoressa Soarawee Weerasopone offre consulenze specialistiche presso la sede centrale dell'ospedale di Bangkok. Prenota una consulenza. È possibile fissare un appuntamento presso l'Ospedale Samitivej Sriracha chiamando il reparto di urologia al numero 088-022-1445.

Domande frequenti sull'incontinenza urinaria da sforzo

L'incontinenza urinaria da sforzo è causata da un indebolimento dei muscoli del pavimento pelvico e/o dello sfintere uretrale che portano alla perdita involontaria di urina quando si verificano aumenti della pressione intra-addominale, come durante tosse, starnuti, risate, corsa o sollevamento di pesi.

L'incontinenza urinaria da sforzo (SUI) è causata da debolezza o danno ai muscoli del pavimento pelvico e allo sfintere uretrale, che normalmente mantengono l'uretra chiusa durante gli aumenti di pressione. Le due cause principali sono: (1) disfunzione dei muscoli del pavimento pelvico - dovuta a obesità, menopausa, gravidanza, trauma da parto vaginale o tosse/stitichezza cronica; e (2) danno neuromuscolare da precedenti interventi chirurgici pelvici - in particolare prostatectomia radicale negli uomini o interventi ginecologici maggiori nelle donne. Qualsiasi fattore che indebolisce il meccanismo di continenza consente la fuoriuscita di urina quando la pressione addominale aumenta.

Gli esercizi di Kegel aiutano davvero l'incontinenza da stress?

Sì, gli esercizi di Kegel sono il trattamento di prima linea più importante per l'incontinenza urinaria da sforzo (SUI). Se eseguiti correttamente e con costanza (3 serie da 10 contrazioni mantenute per 10 secondi, tre volte al giorno), rafforzano i muscoli del pavimento pelvico che sostengono l'uretra. Molte pazienti con SUI lieve o moderata ottengono un miglioramento significativo o la completa continenza con il solo allenamento dedicato di Kegel, senza bisogno di farmaci o interventi chirurgici. I risultati diventano solitamente evidenti dopo 6-12 settimane di pratica costante. Un fisioterapista o uno specialista del pavimento pelvico può confermare la corretta tecnica.

How is stress incontinence told apart from urge incontinence?

Stress incontinence leaks on physical effort — coughing, laughing, lifting — with no warning urge. Urge incontinence leaks after a sudden compelling need to pass urine. The distinction matters because the treatments differ completely, and many women have both, which is called mixed incontinence. Where the history is unclear or symptoms are mixed, a urodynamic study measures bladder and urethral behaviour during filling and straining, and establishes which mechanism is dominant.

La chirurgia per l'incontinenza da stress dovrebbe essere presa in considerazione quando le terapie conservative, come gli esercizi di Kegel e le modifiche dello stile di vita, non sono efficaci, o quando i sintomi sono gravi e interferiscono significativamente con la qualità della vita. È importante consultare un medico per determinare l'opzione di trattamento più adatta al singolo caso.

Surgery is recommended when behavioral therapy and medications have not provided adequate symptom control, or when the SUI is severe enough to significantly affect daily life. The mid-urethral sling (MUS) procedure is the gold standard surgical treatment for female SUI, and urethral bulking agent injection is a less invasive intermediate option. Neither procedure is performed at Bangkok Hospital Headquarters; assessment, urodynamic study and medical treatment are provided here, and a referral to a centre offering surgery can be arranged when it is needed.

Disclaimer: Questo contenuto è stato scritto e revisionato dal Dr. Soarawee Weerasopone, urologo certificato presso la sede centrale del Bangkok Hospital. È destinato unicamente a scopi educativi e non costituisce un parere medico. Nessun parere medico, diagnosi o prescrizione viene fornito tramite canali di messaggistica personale. Consultare sempre un professionista sanitario qualificato prima di iniziare qualsiasi trattamento medico.