Stress incontinence: why it occurs

Abstract

Stress urinary incontinence (SUI) is defined by the international Continence Society (ICS) in 2002 as the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing.

Almost all surveys concluded that SUI is the most common type of urinary incontinence (UI) in women with about 50% of the incontinent women have SUI. The prevalence of SUI is highest in the younger age group (<55 years) with a peak in the 4th decade (35–44 years). Risk factors: genetic factors may have a role in the development of SUI. Caucasian women are more susceptible than the African-American ladies. SUI is more common during pregnancy but it is most likely to be transient. Obesity is an established risk factor. All conditions that increase intra-abdominal pressure would increase the risk of SUI including constipation, lung diseases and some occupations. SUI could be a side effect of some medications, such as alpha-adrenoceptor antagonists. Pelvic organ prolapse strongly correlates with SUI. There is association between impaired mobility and incontinence. However, it remains controversial whether pelvic floor surgery, radiotherapy and menopause have any effect on developing SUI later in life. Pathophysiology: there are currently two patho-anatomical explanations for SUI: anatomical defects leading to bladder neck/urethral hypermobility and/or neuromuscular defects resulting in intrinsic sphincter deficiency (ISD).