Stress incontinence Health Article

Definition

Stress incontinence is an involuntary loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, or exercise.

Alternative Names

Incontinence - stress

Causes, incidence, and risk factors

The ability to hold urine and control urination depends on the normal function of the lower urinary tract, the kidneys, and the nervous system. You must also have the ability to recognize and respond to the urge to urinate.

Stress incontinence is a bladder storage problem in which the strength of the muscles (urethral sphincter) that help control urination is reduced. The sphincter is not able to prevent urine flow when there is increased pressure from the abdomen.

Stress incontinence may occur as a result of weakened pelvic muscles that support the bladder and urethra or because of a malfunction of the urethral sphincter. The weakness may be caused by:

• Brain or nervous system (neurological) injury
• Injury to the urethral area
• Some medications
• Surgery of the prostate or pelvic area

Stress urinary incontinence is the most common type of urinary incontinence in women.

Stress incontinence is often seen in women who have had multiple pregnancies and vaginal childbirths, and whose bladder, urethra, or rectal wall stick out into the vagina (pelvic prolapse).

Risk factors for stress incontinence include:

• Being female
• Childbirth
• Chronic coughing (such as chronic bronchitis and asthma)
• Getting older
• Obesity
• Smoking

Symptoms

Involuntary loss of urine is the main symptom. It may occur when:

• Coughing
• Sneezing
• Standing
• Exercising
• Engaging in other physical activity

Signs and tests

The health care provider will perform a physical exam, including a:

• Genital exam in men
• Pelvic exam in women
• Rectal exam

In some women, a pelvic examination may reveal that the bladder or urethra is bulging into the vaginal space.

Tests may include:

• Inspection of the inside of the bladder (cystoscopy)
• Pad test (after placement of a preweighed sanitary pad, the patient is asked to exercise -- following exercise, the pad is reweighed to determine the amount of urine loss)
• Pelvic or abdominal ultrasound
• Post-void residual (PVR) to measure amount of urine left after urination
• Rarely, an electromyogram (EMG) is performed to study muscle activity in the urethra or pelvic floor
• Tests to measure pressure and urine flow (urodynamic studies)
• Urinalysis or urine culture to rule out urinary tract infection
• Urinary stress test (the patient is asked to stand with a full bladder, and then cough)
• X-rays with contrast dye of the kidneys and bladder

The health care provider may also measure the change in the angle of the urethra when at rest and when straining (Q-tip test). An angle change of greater than 30 degrees often means there is significant weakness of the muscles and tissues that support the bladder.