Stress incontinence

Urge incontinence is a leakage of urine associate with a strong urgency to urinate that cannot be controlled.

The presence of both is referred to as mixed urinary incontinence.

Management strategy differs on the basis of the type of urinary incontinence.

Stress incontinence manifests when intra-abdominal pressure exceeds urethral pressure with the resulting leakage of urine when coughing, sneezing, and exercising.

Stress urinary incontinence is leakage of urine that is caused by sudden pressure on the bladder.

It occurs during activities that increase the amount of pressure on the bladder: coughing, sneezing, laughing, and exercising.

The pressure causes opening of the sphincter muscles which normally  help prevent urine leakage.

Stress urinary incontinence is a common medical problem especially in women as about 1 in 3 women are affected by this condition at some point in their lives.

The main mechanisms of stress incontinence include urethral hyper mobility with the loss of support of the pelvic floor musculature or vaginal connective tissue, such that urethra and bladder neck do not close sufficiently in response to increased intra-abdominal pressure. 

The second  mechanisms includes intrinsic sphincter deficiency because of loss of urethral mucosal and musculature didn’t for urethra closure,leading to poor urethral closure.

Intrinsic sphincter deficiency is  associated with more severe symptoms.

The prevalence of stress incontinence among adults women varies widely depending upon the period evaluated by time, the population studied, and symptom severity.

Urinary incontinence is under recognized and under reported with fewer  than 40% of affected women seeking care.

Stress incontinence prevalence increases with age, reaching a peak of 50% among women 40 years of age and older, and is higher among white than black or Hispanic women.

Additional risk factors include: pregnancy, vaginal delivery, and higher body mass index.

Vaginal delivery is associated with a risk of stress incontinence that is twice as high as that was cesarean delivery.

Women with stress and conscience have a 70% chance of reported continued symptoms at four years after onset, and 60% report symptoms eight years after onset.

A pelvic examination provides information about vulvovaginal atrophy, skin changes due to incontinence or pad use, and pelvic organ prolapse. 

A pelvic examination provides an assessment of pelvic floor musculature and evaluates anatomical factors that may be associated with urinary leakage. 

A urinalysis is recommended during evaluation to rule out urinary tract infections.

As obesity and weight gain are risk factors for stress incontinence weight loss programs have demonstrated reduced episodes of incontinence.

A 5 to 10% reduction in bodyweight reveals a modest improvement in stress incontinence 1 to 2.9 years after the intervention.

Pelvic floor muscle training, Kegel exercises has been shown to reduce the number of leakage episodes and the amount of leakage.

About 74% of women who undergo pelvic floor muscle training for 3 to 6 months,  report cure or improvement, as compared with 11% of women  who receive  no treatment or an inactive control treatment.

Vaginal devices for stress incontinence include pessaries.

Incontinence pessaries or intravaginal devices that have a knob positioned under the urethra to Increase urethral resistance  and reduce symptoms of incontinence.

Duloxetine, a selective serotonin-norepinephrine reuptake inhibitor  has been shown to reduce stress incontinence as compared with placebo, but the effect is small and adverse effects may occur.

Acupuncture may reduce stress incontinence in the short term.

Surgery is the most effective option for stress incontinence.

Lifetime risk of primary surgery for stress urinary incontinence in women is about 13% in the United States.

The benefits of mid urethral mesh sling, Burch colposuspension, pubovaginal sling and urethral bulking are procedures they have been demonstrated.

The midurethral mesh sling surgery is the most commonly performed procedure, which is minimally invasive, outpatient, of 30 minute duration with highly effective response and low rate of complications.

Single incision mini-slings are non-inferior to standard midurethral slings with respect to patient reported success at 15 and 36 month follow-up.

The single incision mini sling approach can be used without general anesthesia and avoids abdominal surgery, but is associated with a higher likelihood of repeat surgery and dyspareunia than midurethral mesh slings.

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