Stress Incontinence

Stress incontinence is one of the most common types of urinary incontinence.

Stress incontinence is leakage from the bladder that occurs with any increase in abdominal pressure. Common causes of the bladder leakage include coughing, laughing, sneezing, exercise, lifting or intercourse. Stress incontinence can be seen in all age groups and in both sexes. More women experience stress incontinence that men suggesting the possibility that events such as vaginal delivery may contribute to development of bladder leakage. Though stress incontinence is very common and has been effectively treated for years a definite anatomic cause for this type of bladder leakage is not known. The two most popular theories as to the cause of incontinence include urethral incompetence (loss of either support or intrinsic function of the female urethra) or hypermobility of the bladder neck and proximal urethra (movement opens the back part of the urethra allowing bladder leakage).

Diagnostic Strategies

A good history helps greatly in diagnosing stress incontinence. Several questions regarding events leading to bladder leakage will be posed by your clinician. After sorting through the history a physical examination will be performed. In women particular attention will be paid to the vaginal examination. Weaknesses in the vaginal wall (prolapse) often occur in women with stress incontinence. Presence of prolapse is important as it may change potential surgical plans. Irregularities of the urethra are noted at the time of examination as well. A urinalysis is performed to rule out bladder infection as a few women with an infection can present with incontinence. Occasionally the urinalysis can show blood (hematuria) necessitating further evaluation. In the office, a post-void residual (measurement of urine present in the bladder after a full attempt at emptying) is performed to confirm complete emptying. Those patients with an incompletely emptied bladder may have overflow incontinence. Given the complexity of most incontinence issues an urodynamic evaluation may be performed to completely assess bladder function prior to intervention. Occasionally, cystoscopy (looking in bladder with a telescope) may be performed prior to surgery.