• Clinical science

Stress incontinence

Abstract

Stress incontinence refers to a condition with involuntary leakage of urine, which occurs following any activity associated with raised intra-abdominal pressure (e.g., coughing, sneezing). Stress incontinence is twice as common in women than in men. The prevalence of this form increases with age. Stress incontinence can result from a variety of conditions (such as pelvic floor weakness, intrinsic sphincter deficiency, etc.), the underlying mechanism of which is an increase of bladder pressure above sphincteric resistance, which leads to expelling of urine. The characteristic history is one of 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: > (approx. 2:1)
  • Prevalence increases with age.

Epidemiological data refers to the US, unless otherwise specified.

Etiology

  • Urethral hypermobility
  • Intrinsic sphincter deficiency
  • Risk factors include:
  • See also “Etiology” of urinary incontinence

Classification

Incontinence severity according to Stamey

  • Grade I: loss of urine when coughing, sneezing, or laughing
  • Grade II: loss of urine when walking or standing up
  • Grade III: loss of urine when in a supine position

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

Diagnostics

References:[1]

Differential diagnoses

The differential diagnoses listed here are not exhaustive.

Treatment

Conservative treatment

Surgical procedures

References:[1]