Urinary Incontinence: Stress

Introduction

• Description: Urinary incontinence is a sign, symptom, and disease all at the same time. Stress incontinence is almost exclusively limited to women and is the passive loss of urine in response to increased intraabdominal pressure, such as that caused by coughing, laughing, or sneezing, in the absence of bladder contraction. The volume of urine lost is generally proportional to the amount of pressure involved.

• Prevalence: Stress incontinence affects 10%–15% of all women and 30%–60% of women after menopause.

• Predominant Age: Mid-reproductive age and older. Stress incontinence becomes more common during the 40s and beyond and is most common after menopause.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Unequal transmission of intraabdominal pressure to the bladder and urethra. Generally associated with an anatomic defect such as a cystocele, urethrocele, or cystourethrocele. The degree of incontinence is often not correlated with the scale of pelvic relaxation. Intrinsic sphincteric deficiency can also lead to stress incontinence.

• Risk Factors: Multiparity, mode of delivery, obesity, smoking, chronic cough, heavy lifting, intrinsic tissue weakness, or atrophic changes resulting from estrogen loss.

Signs and Symptoms

• Loss of small spurts of urine in association with transient increases in intraabdominal pressure

• Associated cystocele, urethrocele, or cystourethrocele

Diagnostic Approach