• Clinical science

Stress incontinence

Summary

Stress incontinence is the involuntary leakage of urine following any activity associated with raised intra-abdominal pressure (e.g., coughing, sneezing). It is twice as common in women than in men and its prevalence increases with age. Stress incontinence can be caused by a variety of conditions (e.g., pelvic floor weakness, intrinsic sphincter deficiency, etc.), the underlying mechanism of which is an increase in bladder pressure that exceeds sphincter resistance, which leads to expelling of urine. Individuals with the condition have predictable, small-volume urinary loss, typically during physical exertion, with no history of irritative symptoms of the bladder (urgency or frequency). Diagnosis is based on physical examination, a detailed medical history, and imaging studies. Treatment usually consists of leakage management measures (diapers, catheterization, etc.), drugs (anticholinergics), and in severe cases, surgery (sling operations, taping, etc.).

Epidemiology

  • Sex: > (∼ 2:1)
  • Prevalence increases with age.

References:[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[1][2]

Clinical features

  • Loss of urine during physical activity that leads to increased intra-abdominal pressure (e.g., laughing, sneezing, coughing, exercising)
  • Frequent, predictable, small-volume urine losses with no urge to urinate prior to the leakage

References:[1]

Diagnostics

References:[3][1]

Differential diagnoses

The differential diagnoses listed here are not exhaustive.

Treatment

Conservative treatment

Surgical procedures

  • Indicated if conservative treatment does not provide sufficient improvement of symptoms
  • Procedure of choice: midurethral sling to elevate the urethra
  • Alternative: urethropexy
    • Surgical fixation of a displaced urethra and bladder neck to nearby tissue to prevent involuntary urine leakage
    • Formerly the gold standard (before the introduction of midurethral slings) but now used less because it requires laparotomy or laparoscopy and is associated with more complications
    • Mainly reserved for patients who also require repair of pelvic organ prolapse

References:[1][4][5][6]