Stress Incontinence

Stress incontinence is one of the most common types of incontinence in women. An important note is that when these patients leak, they only leak a small amount. Often they will describe a "squirt" or "spurt" with activities and usually not a large volume loss. Most women with stress incontinence will fit into this category. These women usually will have a "dropped" bladder or "cystocele". The most common cause is thought to be damage to the pelvic floor support due to childbirth. This leads to a movement or "hypermobility" or the urethra and bladder neck with any increase in abdominal pressure. There are however women that have stress incontinence that have never had children. They probably have a congenital weakness of the pelvic muscles and tissue.

• Women with stress incontinence due to a defective urethra may lose a large amount of urine. They will notice this especially when standing with a full bladder. The urethra may not be "hypermobile" at all. This is because there is no resistance to urine out flow and the urine will just run out like water out of a pail with a hole in it. Patients with this type of incontinence are rare, but very important to identify since treatment for this type of stress incontinence is treated totally different.
• Most patients with stress incontinence will therefore only need to wear a pad or panty-liner and will usually not use the bulkier products, like Depends, that are made to catch larger volumes of urine.
• Also, patients with pure stress incontinence will have no associated symptoms of urgency (the severe urge to go the bathroom when the bladder is full).

Causes

• The most common type of stress incontinence is "genuine" stress incontinence due to hypermobility of the bladder neck.
• Damage to the tissues and ligaments that support the bladder and the neck of the bladder commonly occurs during childbirth. It can also be found in patients with congenital weakness of the support tissues, or in patients that do a lot of repetitive heavy lifting.

Once these support tissues and ligaments are damaged, as a patient strains down, coughs, sneezes, etc; the bladder and the neck of the bladder actually rotate downward. In doing so, the angle between the bladder and the urethra is lost (straightened) so that now the pressure the urine is under is directed down the middle of the urethra instead of being resisted by the tissues and muscles surrounding the urethra. The net effect is that bladder pressure is greater then urethral pressure and leakage occurs.