What is stress urinary incontinence?

Updated: Mar 19, 2019
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Episodes of stress incontinence occur during periods of increased intra-abdominal pressure. Triggers of stress incontinence are predictable: typically, patients report involuntary urine loss during coughing, laughing, and sneezing. Incontinence worsens during high-impact sports activities such as golf, tennis, or aerobics. Leakage is more common while standing than while lying down (eg, at night).

Little urine is lost, unless the condition is severe. Typically, affected patients use thin to medium-thickness pads. The number of pads used ranges from 1-3 per day.

Irritative voiding symptoms, such as urinary frequency, urgency, and nocturia, are typically absent. The presence of irritative voiding symptoms should raise an index of suspicion for overactive bladder. Irritative voiding symptoms in combination with hematuria (gross or microscopic) warrant a complete bladder tumor workup.

Stress urinary incontinence due to severe intrinsic sphincter deficiency produces much more severe symptoms than cases due principally to urethral hypermobility. Involuntary urine loss occurs not only with coughing, laughing, and sneezing but also with standing up from a sitting position. Patients describe continuous dribbling of urine and typically require a high volume of pad use.

This degree of urine loss is similar that seen with vesicovaginal or ureterovaginal fistula. These patients complain of being wet all the time and use large amounts of thick pads to stay dry. If suspecting a fistula, be sure to ask about previous surgical history, including a hysterectomy. Although uncommon, consider ectopic ureter/ureterocele in the differential diagnoses.

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