- Clinical science
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.).
- Sex: ♀ > ♂ (approx. 2:1)
- Prevalence increases with age.
Epidemiological data refers to the US, unless otherwise specified.
- See for general diagnostic measures
- Marshall test (conducted by elevating the bladder neck). The Marshall test is positive if no urine is released upon renewed coughing thus confirms the diagnosis.
- Vaginal and rectal examination should be performed to exclude a cystocele or rectocele.
- Urinary stress test; : Leakage of urine under conditions that cause increased abdominal pressure (e.g., Valsalva maneuver or forced coughing) is a sign of stress incontinence.
The differential diagnoses listed here are not exhaustive.
- Pelvic floor muscle exercises (Kegel exercises), lifestyle changes (e.g., alcohol cessation), and use of continence pessaries
- Possible pharmacotherapy
- Indicated if insufficient improvement with conservative treatment
- Procedure of choice: midurethral sling to elevate the urethra
- Alternative: urethropexy (colposuspension) used to be the gold standard but less desired because it requires laparotomy or laparoscopy and has more complications
- Mainly reserved for patients also requiring repair of pelvic organ prolapse
- Less common alternatives