Urinary stress incontinence (USI) is the passage of urine done without conscious control especially in the case of increased abdominal pressure. Typically, the urine passed is minimal. The cause behind this condition is poorly understood, although there are a number of factors that put individuals at a greater risk of developing USI. Women are more affected by this condition than men, and some of the risk factors specific to the former include pregnancy, vaginal delivery, and menopause [1] [2] [3]. Risk factors that apply to both men and women include obesity, chronically raised intraabdominal pressure as found in chronic obstructive pulmonary disease (COPD), urethral injury, pelvic surgery and smoking [4] [5] [6].

USI occurs when there is an abrupt increase in intraabdominal pressure, usually when coughing, laughing, sneezing, lifting heavy objects, or during physical exertion such as sports. Irritative voiding symptoms such as frequency and urgency, are not part of the clinical picture, and if present, may be indicative of an overactive bladder. The additional presence of hematuria may be a sign of bladder cancer.

USI may arise from a defect in the urethral sphincter, or from the urethra itself. If the urethral sphincter is responsible, symptoms are typically more pronounced, exemplified by urine passage during the action of standing up, or continuous dribbling. The features may be similar to those of a fistula, which if suspected, may be investigated.

• Weakness

  […] much tension, not weakness that comes from flopping around.” [irishexaminer.com]

  It's thought SUI is due to weakness in the sphincter muscle and the pelvic floor muscles that support the organs in your pelvis and abdomen. [netdoctor.co.uk]

  A weak pelvic floor and a poorly supported uretheral sphincter cause stress incontinence. [healthcommunities.com]

  Stress incontinence can be caused by a variety of conditions (e.g., pelvic floor weakness, intrinsic sphincter deficiency, etc.), the underlying mechanism of which is an increase in bladder pressure that exceeds sphincter resistance, which leads to expelling [amboss.com]

  It occurs because of weakness of the muscles of the pelvic floor, which support the pelvic organs and control the urinary sphincter. [yoatzot.org]

• Asymptomatic

  At 13 months of follow up, this woman was asymptomatic and satisfied. As documented by this case here, the Remeex procedure is particularly suitable in selected high-risk patients where TVT and TVT live slings are less effective. [ncbi.nlm.nih.gov]

  The development of such symptoms can create significant dissatisfaction in a patient who was previously asymptomatic. [obgmanagement.com]

  Small enteroceles are usually asymptomatic. Can occur following pelvic surgery. The neck of the hernial sac is usually sufficiently wide to make strangulation very rare. [patient.info]

  良性前立腺増殖症 (良性前立腺肥大症) benign renal tumor良性腎腫瘍 bladder cancer膀胱癌 bladder outlet obstruction (BOO) 膀胱出口閉塞症 blood purification血液浄化（療法） Bowmann's capsuleボウマン嚢 c calix　（calyx）腎杯 capsule被膜、包、嚢、鞘、莢膜（きょうまく）、カプセル cast円柱 catheterカテーテル cerebrum大脳 chance hematuriaチャンス血尿（Asymptomatic [tokyo-med.ac.jp]

  Asymptomatic bacterial colonization is common and does not pose a health hazard. However, untreated symptomatic UTIs may lead to urosepsis and death. [emedicine.medscape.com]

• Crying

  These simple and noninvasive interventions can not only lead you once more to crying tears of joy, but can contribute to your overall well-being! [bottomlineinc.com]

  However, if one were crying profusely due to emotional stress and straining the abdominal area then this could be an activity that could trigger urine leakage, although it is not the underlying cause. [medfriendly.com]

• Sneezing

  This can occur when patients cough, sneeze or lift heavy objects. There are numerous predisposing factors. [symptoma.com]

  The term “stress incontinence” is meant to describe the condition of involuntary leakage of urine caused by somatic stress (lifting, coughing, laughing, sneezing etc). [ics.org]

  More Definitions for stress incontinence Medical Definition of stress incontinence : involuntary leakage of urine from the bladder accompanying physical activity (as in laughing, coughing, sneezing, or physical exercise) which places increased pressure [merriam-webster.com]

  Stress incontinence happens when physical movement or activity — such as coughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder. Stress incontinence is not related to psychological stress. [mayoclinic.org]

  Stress urinary incontinence – accidental leaks when you cough, laugh or sneeze – is the most common form of urinary incontinence in women. [netdoctor.co.uk]

• Hypotension

  Adverse effects include hypotension, fatigue, asthenia, and dizziness. [merckmanuals.com]

  Typical anticholinergic adverse effects can be expected, including dry mouth, constipation, dry eyes, blurred vision, orthostatic hypotension, and increased heart rate. [emedicine.medscape.com]

• Urticaria

  […] youtu.be/q5t-an5-Ors Tuberculosis (तपेदिक) https://youtu.be/NKA7GLiXGW8 Tumours & Growths (ट्यूमर - सभी प्रकार) https://youtu.be/LLxQjfX0rOE Typhoid (टाईफाईड) https://youtu.be/Gq2geYTiMc0 Ulcer (all types) - अल्सर (सभी प्रकार) https://youtu.be/eBVpQVeXY4Y Urticaria [agrawalreiki.blogspot.com]

• Stroke

  Some risk factors for female incontinence: Childbirth Urinary tract infections Menopause Prior pelvic surgeries – radical hysterectomy Increased weight Neurologic illnesses – multiple sclerosis, diabetes, or stroke Advanced age Treatments If you have [uchospitals.edu]

  Neurological diseases (such as Parkinson's disease and multiple sclerosis) can also result in urge incontinence, as can a stroke. [health.harvard.edu]

  Additionally, stroke, Parkinson’s disease and multiple sclerosis affect the brain and have been linked to problems of urination. [news-medical.net]

  Some diseases and conditions: Diabetes, kidney disease, spinal cord injury, and neurologic diseases, for example, a stroke, increase the risk. Prostate disease: Incontinence may present after prostate surgery or radiation therapy. [medicalnewstoday.com]

  Urinary tract diseases, infections, strokes, surgeries and treatments for pelvic cancers can also cause UI. Tumors or obstructions. Poor kidney function. Certain medications. Certain foods or beverages. [aurorahealthcare.org]

• Hyperactivity

  […] discretionary, depending on the severity of the conditions and the reason for the encounter. any associated overactive bladder ( ICD-10-CM Diagnosis Code N32.81 Overactive bladder 2016 2017 2018 2019 Billable/Specific Code Applicable To Detrusor muscle hyperactivity [icd10data.com]

  Drugs may be required to suppress urgency symptoms due to detrusor overactivity (hyperactivity) with impaired contractility. [merckmanuals.com]

  WQbbB-Q6Ldc Hip (कूल्हे) https://youtu.be/k6fIxvSDn74 Hole in Heart (ह्रदय छिद्र) https://youtu.be/iwQCukrKOgI Honesty (ईमानदारी) https://youtu.be/TaRR0bUZr8c Humility (विनम्रता) https://youtu.be/oybalq5FRs8 Hydrocele (अण्डवृद्धि) https://youtu.be/WHujkiJi0YU Hyperactivity [agrawalreiki.blogspot.com]

  The urethra is healthy, but the bladder is hyperactive or overactive. Pharmacologic therapy for stress incontinence and an overactive bladder may be most effective when combined with a pelvic exercise regimen. [emedicinehealth.com]

• Hyporeflexia

  Detrusor-sphincter dyssynergia (25%) and detrusor hyporeflexia (20%) also are common. Obstructive findings are much more common in males. [emedicine.medscape.com]

• Areflexia

  Urodynamically, both detrusor hyperreflexia and areflexia have been found. CNS neoplasms may result in incontinence. [emedicine.medscape.com]

• Incontinence

  There are many studies available for the investigation of urinary incontinence. [symptoma.com]

  Stress urinary incontinence – accidental leaks when you cough, laugh or sneeze – is the most common form of urinary incontinence in women. [netdoctor.co.uk]

  Stress Incontinence Stress incontinence is the most common form of urinary incontinence (involuntary or uncontrollable urine loss). [medfriendly.com]

  We also assessed postoperative urge incontinence, voiding dysfunction, and adverse events. [ncbi.nlm.nih.gov]

  The two most common types of urinary incontinence are urge and stress incontinence. Urge incontinence occurs when the bladder muscles contract at the wrong time. [theperimenopauseblog.com]

• Urinary Incontinence

  Stress urinary incontinence – accidental leaks when you cough, laugh or sneeze – is the most common form of urinary incontinence in women. [netdoctor.co.uk]

  MATERIALS AND METHODS: One hundred patients with stress urinary incontinence underwent the TVT procedure as part of an observational study. [ncbi.nlm.nih.gov]

  You are here: Urology Textbook > Bladder > Male stress urinary incontinence Definition of Stress Urinary Incontinence The International Continence Society (ICS) defines urinary incontinence as "the complaint of any involuntary loss of urine". [urology-textbook.com]

  […] rndx stress urinary incontinence, genuine stress incontinence, incontinence stress urinary, incontinence stressed urinary, Incontinence;urine;stress, incontinence stress, incontinence urinary stress, urinary stress incontinence, Stress incontinence - [fpnotebook.com]

• Urinary Stress Incontinence

  Our results suggest that the rhabdosphincter is a substantial component of the continence mechanism in female urinary stress incontinence. [ncbi.nlm.nih.gov]

  Urinary stress incontinence (USI) is the passage of urine done without conscious control especially in the case of increased abdominal pressure. Typically, the urine passed is minimal. [symptoma.com]

Physical examination, of the genitals, pelvis, and rectum, and a urinary stress test are routinely done in the investigation of USI. A history of stress symptoms alone is not adequate for diagnosis, nor is it an indication for surgery [7].

There are many studies available for the investigation of urinary incontinence. A combination of a history of stress incontinence, a postvoid residual volume of less than 50 milliliters, a positive cough test and bladder capacity of more than 400 milliliters, has been suggested in the literature, for greater efficiency in the diagnosis of USI. This may be followed by more extensive urinary studies.

Initial investigations involve voiding diaries, pad test, urinalysis, and ultrasound. Further modalities include urodynamic and contrasted radiological studies of the urogenital tract.

Urodynamic studies need not be carried out on every patient, however, they are important if surgical intervention is planned [8]. This is because the former is able to objectively demonstrate the presence of urinary stress incompetence. It is also recommended that the above studies be carried out in patients with prior failed therapy, and if neuropathy is suspected.

Among the urodynamic studies that can be done are post-void urine volume, filling cystometry, and uroflow. More extensive exams include video-urodynamic studies. These tests are important in planning treatment, predicting its outcome and delineating possible reasons for treatment failure.

After 3 months of HCl duloxetine treatment the mean ALPP was 59.1 cm H(2)O, the mean MUCP was 67.3 cm H(2)O and the mean RLPP was 45.1 cm H(2)O. There was a statistically significant correlation among RLPP, MUCP and ALPP before treatment. [ncbi.nlm.nih.gov]

These tests are important in planning treatment, predicting its outcome and delineating possible reasons for treatment failure. [symptoma.com]

The prognosis of this tumor is excellent and no malignant degeneration has been reported. The most common presentations are obstructive voiding symptoms, irritative symptoms, and hematuria. [ncbi.nlm.nih.gov]

Good prognosis is associated with young age, good physical health and a BMI within normal limits. [patient.info]

Outlook (Prognosis) Getting better takes time, so try to be patient. Symptoms most often get better with nonsurgical treatments. However, they will not cure stress incontinence. Surgery can cure some people of stress incontinence. [pennmedicine.org]

What Is the Prognosis of Urinary Incontinence? Urinary incontinence is a treatable condition with an excellent prognosis. Medical and surgical treatments for urinary incontinence can have very high cure rates. [emedicinehealth.com]

References:[1][4][5][6] Stress incontinence Summary Epidemiology Etiology Clinical features Diagnostics Differential diagnoses Treatment Conservative treatment Surgical procedures [amboss.com]

The etiology of the incontinence may be iatrogenic, environmental, situational, or disease related. [emedicine.medscape.com]

Increased urethral mobility Intrinsic sphincter dysfunction Loss of urine with physical exertion or increases in intra-abdominal pressure (e.g., sneezing, coughing, laughing) Most common in younger women Second most common type in older women Mixed Mixed etiology [aafp.org]

ETIOLOGY There are several factors believed to cause or promote SUI or lead to decompensation resulting in SUI ( Table 1 ). [glowm.com]

The etiology of the initial surgical failure (intrinsic sphincter dysfunction [ISD], recurrent hypermobility, obstruction, instability) should be understood before undertaking a repair. [ncbi.nlm.nih.gov]

Epidemiology References:[1] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

No difference in epidemiologic and preoperative urinary functional status (SUI stage, and pollakiuria, nocturia, and urgency rates) was found between the groups. [ncbi.nlm.nih.gov]

Design: A cross-sectional epidemiologic survey. [erj.ersjournals.com]

"Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity. J Clin Epidemiology. 1995; 48(3): 339-345. [ Links ] 21. McGuire EJ, Woodside JR, Borden TA, Weiss RM. [scielo.org.co]

This article focuses on the pathophysiology of genuine or urodynamic stress incontinence (USI) and its surgical management. Until now more than 200 surgical techniques have been described for the treatment of USI. [ncbi.nlm.nih.gov]

Urge incontinence pathophysiology Urge incontinence is involuntary urine loss associated with a feeling of urgency. [emedicine.medscape.com]

Pathophysiology • Urethral hypermobility (80%) Due to descent of the bladder neck and proximal urethra. • Intrinsic Sphincter deficiency (20%) 5. [slideshare.net]

Pathophysiology and management. London: Butterworths, 1985; pp. 112–128 Google Scholar 23. Shafik A. The posterior approach in the treatment of pudendal canal syndrome. Coloproctology 1992; 14:310–315 Google Scholar 24. Warwick R, Williams PL. [link.springer.com]

It normally maintains a tight seal thanks to the sphincter muscle surrounding the urethra, to prevent involuntary loss of urine. [incostress.co.uk]

At times when it's not appropriate to urinate, the brain sends back an inhibitory signal to keep the sphincters closed and prevent voiding. [youtube.com]

Fast twitch muscle fibers are very important to prevent sudden stress situations and prevent loss of control. [medfaxxinc.com]

Can stress urinary incontinence be prevented? Doing kegel exercises may help prevent symptoms. Women who are pregnant may want to do kegels during and after pregnancy to help prevent incontinence. [my.clevelandclinic.org]

CAN STRESS INCONTINENCE BE PREVENTED? Performing Kegel exercises, which were discussed in the treatment section, can help prevent stress incontinence, especially if performed during and after pregnancy and later in life. [medfriendly.com]

1. Kuh D, Cardozo L, Hardy R. Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort. J Epidemiol Community Health. 1999;53(8):453–458.
2. Groutz A, Gordon D, Keidar R, et al. Stress urinary incontinence: prevalence among nulliparous compared with primiparous and grand multiparous premenopausal women. Neurourol Urodyn. 1999;18(5):419–425.
3. Foldspang A, Mommsen S, Djurhuus JC. Prevalent urinary incontinence as a correlate of pregnancy, vaginal childbirth, and obstetric techniques. Am J Public Health. 1999;89(2):209–212.
4. Brown JS, Seeley DG, Fong J, Black DM, Ensrud KE, Grady D. Urinary incontinence in older women: Who is at risk? Study of osteoporotic fractures research group. Obstet Gynecol. 1996;87(5 Pt 1):715–721.
5. Magon N, Kalra B, Malik S, Chauhan M. Stress urinary incontinence: What, when, why, and then what? J Midlife Health. 2011;2(2):57-64.
6. Bump RC, McClish DK. Cigarette smoking and urinary incontinence in women. Am J Obstet Gynecol. 1992;167(5):1213–1218.
7. Summitt RL Jr, Stovall TG, Bent AE, Ostergard DR. Urinary incontinence: correlation of history and brief office evaluation with multichannel urodynamic testing. Am J Obstet Gynecol. 1992;166(6 Pt 1):1835-40;discussion 1840-1844.
8. Rovner ES, Wein AJ. Treatment Options for Stress Urinary Incontinence. Rev Urol. 2004;6(Suppl 3):S29-S47.