Stress Incontinence

Definition and Clinical Features

According to the ICS, stress incontinence is defined in terms of a symptom, a sign, and a condition.

The symptom is discussed as the affected person’s complaint of involuntary escape of urine during any type of physical exercise including changing positions, coughing, and sneezing.

The sign denotes demonstrable loss of urine with physical exertion.

The condition of stress incontinence is defined as an “involuntary loss of urine occurring when, in the absence of detrusor contraction, the intravesical pressure exceeds the maximum urethral pressure” (ICS Committee, 1990, p. 17).

The condition is caused by sphincteric weakness or an overactive detrusor provoked by physical exertion.

In stress urinary incontinence, a small amount of urine escapes suddenly when the individual experiences an increase in abdominal pressure that occurs with a sneeze, a cough, or laughter.

Stress incontinence often occurs in women who have given birth, although 28% of young nulliparous women athletes surveyed in one study reported episodes of incontinence during exercise (Nygaard, Thompson, Svengalis, & Albright, 1994).

Stress incontinence is aptly named because the pressure or strain from a laugh or cough results in a loss of urine.

The bladder and urethra are normally held firmly in place by muscles and connecting tissue in the pelvis. When you cough, the pressure inside your abdomen increases, and the pressure pushes on your bladder and urethra. If the supporting pelvic muscles or connecting tissues have been damaged or weakened, they may not be able to withstand the force of the cough. The pressure then forces the urethra to open, resulting in urine leaking out.

Many activities that you ordinarily wouldn’t even think about can cause increased pressure in the abdomen and the bladder. Coughing, straining to lift a heavy piece of luggage, aerobic exercise, or even a hiccup can challenge a woman with this problem.

The anatomical structure of a woman’s short urethra and loss of urethrovesical angle as a result of a decrease in pelvic floor tone make stress incontinence more prevalent in women than in men, although men who have had a prostatectomy or perineal surgery may experience stress incontinence as well. In stress incontinence, a small amount of the urine in the bladder escapes rather than the entire contents of the bladder.

Treatment of Stress Urinary Incontinence

There are a number of both non-pharmacological and pharmacological measures available for the treatment of stress urinary incontinence. The Table below summarizes these treatment measures.

Treatment approachManagement options
  • Behavioral therapy
  • Electrical stimulation
  • Treatment of precipitating condition (e.g. cough, atropic vaginitis)
  • Use of continence aids (e.g. pads and/or undergarments, intravaginal or intraurethral devices
  • α-adrenoceptor antagonists (e.g. phenylpropanolamine)
  • Oestrogen-containing hormone replacement therapy
  • Urethral repositioning ‘Sling’ procedures
  • Periurethral injection of collagen, fat, Teflon, macroplastique, hydrogel microballoons
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