Stress incontinence in women

Urinary incontinence is a common condition that affects over 60% of community dwelling women worldwide. (1)

Stress incontinence is defined by the involuntary loss of urine through an intact urethra secondary to an increase in intra-abdominal pressure and in the absence of detrusor activity. It is associated with a defect of the urethral sphincter. Urine loss occurs when the intra-vesical pressure exceeds the maximum urethral pressure. (2,3)

Most patients complain of involuntary loss of urine on coughing or straining. Often, this accompanied by symptoms of frequency and urgency.

The severity of the stress incontinence may be graded:

• associated with severe stress - coughing, sneezing, jogging
• associated with moderate stress - walking up and down stairs
• associated with mild stress - standing

In women, factors such as pregnancy, multiple vaginal deliveries, menopause, obesity, and pelvic surgeries, such as hysterectomy, are significant contributors to stress urinary incontinence. In addition, pelvic organ prolapse, commonly occurring postmenopausal or after childbirth, is often associated with stress incontinence.

High-impact activity (e.g., long-distance running) increases stress on pelvic support structures. This leads to stretching and weakening of the muscles, nerves, and other pelvic structures, and can result in urinary incontinence. (4)

Reference

1. Patel UJ, Godecker AL, Giles DL, et al. Updated prevalence of urinary incontinence in women: 2015-2018 national population-based survey data. Female Pelvic Med Reconstr Surg. 2022 Apr 1;28(4):181-7.
2. Fritel X, Ringa V, Quiboeuf E, et al. Female urinary incontinence, from pregnancy to menopause: a review of epidemiological and pathophysiological findings. Acta Obstet Gynecol Scand. 2012 Aug;91(8):901-10.
3. National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. NG123. Last updated June 2019.
4. Rzymski P, Burzyński B, Knapik M, et al. How to balance the treatment of stress urinary incontinence among female athletes? Arch Med Sci. 2021;17(2):314-22.