Stress Incontinence

Stress incontinence is the unintentional loss of urine. It is most often associated with weakening of the pelvic floor muscles and subsequent hypermobility of the bladder outlet and urethra. Stress incontinence occurs with physical movement or activity, such as coughing, sneezing, laughing, or heavy lifting. Stress incontinence is often seen in older women with previous vaginal deliveries or pelvic surgery. It

Table 4-16 Persistent Urinary Incontinence: Types, Causes, and Treatments



Common Causes

Primary Treatment


Involuntary loss of urine with increases in intraabdominal pressure (e.g., cough, laugh, exercise)

Urethral hypermobility Sphincteric dysfunction Radical prostatectomy

Scheduled voiding

Pelvic muscle exercises

Alpha-adrenergic agonist"

Estrogen (topical)"

Periurethral injection

Surgical bladder neck suspension or sling


Leakage of urine because of inability to delay voiding after sensation of bladder fullness is perceived

Detrusor overactivity Neurologic disorders Spinal cord injury

Antimuscarinic drugs

Topical estrogen (for severe vaginal atrophy or atrophic vaginitis)

Bladder training (including pelvic muscle exercises)


Combination of urge and stress symptoms

Combination of above causes

One or combination of above, targeting most bothersome symptom(s) first


Leakage of urine resulting from mechanical forces on overdistended bladder, or from other effects of urinary retention on bladder and sphincter function

Detrusor failure Neurologic disorders Spinal cord injury Diabetes

Anatomic obstruction

Bladder retraining Surgical removal of obstruction Intermittent catheterization Indwelling catheterization


Urinary accidents associated with inability to toilet, caused by impairment of cognitive or physical functioning, psychological unwillingness, or environmental barriers

Mobility impairment Cognitive impairment

Behavioral interventions with toileting assistance Environmental adaptations Undergarments and pads


is also associated with lack of estrogen in the menopausal woman. Obesity can exacerbate the symptoms of stress incontinence.

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