Difference Between Stress and Urinary Incontinence
Stress urinary incontinence is a specific subtype of urinary incontinence—urinary incontinence is the umbrella term for any involuntary leakage of urine, while stress incontinence specifically refers to leakage that occurs during physical activities that increase abdominal pressure. 1
Understanding the Terminology
Urinary incontinence is the broad diagnostic category encompassing any involuntary loss of urine, regardless of the mechanism or trigger. 2, 3 This umbrella term includes several distinct subtypes, each with different underlying pathophysiology and treatment approaches.
Stress urinary incontinence (SUI) is one specific subtype, defined as involuntary leakage that occurs during:
- Physical exertion or exercise
- Sneezing or coughing
- Laughing
- Lifting or bending over
- Changing positions 1
The underlying mechanism involves a poorly functioning urethral closure mechanism and loss of anatomical urethral support, causing leakage when intra-abdominal pressure increases. 1
Other Major Subtypes of Urinary Incontinence
To fully understand the distinction, it's critical to recognize the other forms of urinary incontinence:
Urge Urinary Incontinence (UUI)
- Defined as involuntary leakage accompanied by or immediately preceded by urgency—a sudden, compelling desire to pass urine 4, 2
- The leakage is triggered by the sensation of urgency rather than physical stress 1, 4
- Treatment differs fundamentally from SUI, focusing on behavioral therapies and antimuscarinic agents or β3-agonists 4
Mixed Urinary Incontinence (MUI)
- Combination of both stress and urge incontinence symptoms occurring in the same patient 1, 4, 2
- Treatment should target the most bothersome component first 4
Overflow Incontinence
- Results from catheterization needs or obstruction/detrusor hypoactivity 3
Clinical Implications for Diagnosis
Accurate differentiation is essential because treatment approaches differ dramatically between subtypes. 1, 2
For stress incontinence, the diagnostic focus includes:
- History of leakage specifically during physical activities that increase abdominal pressure 1, 5
- Cough stress test during physical examination 5, 2
- Assessment of pelvic organ prolapse and urethral hypermobility 1, 5
For urge incontinence, the diagnostic focus includes:
- Urgency episodes documented in voiding diaries 4
- Frequency and nocturia patterns 4
- Consideration of urodynamic testing for refractory cases 4
Treatment Paradigm Differences
The treatment algorithms diverge completely based on subtype:
For stress incontinence:
- First-line: Pelvic floor muscle training with proper supervision 1
- Second-line: Surgical interventions including midurethral slings, colposuspension, or autologous fascial slings 1
- Alternatives: Urethral bulking agents, pessaries 1
For urge incontinence:
- First-line: Behavioral therapies including fluid management, caffeine reduction, and pelvic floor exercises 4
- Second-line: Pharmacotherapy with antimuscarinic agents or β3-agonists 4
- Advanced: OnabotulinumtoxinA injections, sacral neuromodulation 3
Common Pitfall to Avoid
Do not prescribe anticholinergic medications for stress urinary incontinence—they are ineffective for this subtype and have never been shown to work for SUI. 6 These medications are appropriate only for urge incontinence, not stress incontinence. 4 This represents a frequent prescribing error in clinical practice where the subtypes are not properly distinguished. 6