Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed March 2026
What Causes Stress Urinary Incontinence?
Stress urinary incontinence — the type that causes leaking when you cough, sneeze, laugh, lift, or exercise — happens when the support system around your urethra becomes weakened. Despite the name, it has nothing to do with emotional stress. The “stress” refers to the physical pressure placed on your bladder during these activities.
The Support System
Your urethra is held closed by a combination of muscles, ligaments, and connective tissue that form a hammock-like support underneath it. When this support is strong, your urethra stays sealed even when sudden pressure is applied to your abdomen. When it’s weakened, urine can escape during moments of increased pressure.
The urethra is like a valve, and the pelvic floor provides the backstop that keeps it shut. When the backstop weakens, the valve can’t do its job under pressure — literally.
Common Causes and Risk Factors
- Pregnancy and vaginal delivery — the single biggest risk factor. The weight of pregnancy and the stretching during delivery can damage muscles, nerves, and connective tissue
- Menopause and hormonal changes — declining estrogen levels thin the urethral and vaginal tissues, reducing their ability to maintain a seal
- Chronic increased abdominal pressure — from chronic coughing (asthma, smoking), heavy lifting, or constipation
- Obesity — excess weight places continuous strain on the pelvic floor
- Previous pelvic surgery — including hysterectomy, which can alter pelvic support
- Connective tissue disorders — some women are genetically predisposed to weaker tissue
- Aging — natural loss of muscle mass and tissue elasticity over time
It’s Often a Combination
Most women don’t develop stress incontinence from a single cause. It’s usually a combination of factors — perhaps childbirth weakened the foundation, and then hormonal changes after menopause further reduced tissue support, and a chronic cough from allergies added ongoing strain.
Understanding the contributing factors helps us build a better treatment plan. If we can address modifiable risk factors — like optimizing weight or treating a chronic cough — that often enhances the results of other treatments.
What You Can Do
Knowing the causes also points toward solutions. Pelvic floor physical therapy directly strengthens the weakened support. Estrogen therapy can restore tissue health. Weight management reduces ongoing strain. And for women who need more, surgical options like the midurethral sling replace the weakened support with excellent long-term results.
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