Stress incontinence

Alternative Names

Incontinence - stress

Symptoms

Involuntary loss of urine is the main symptom. It may occur when:

• Coughing
• Sneezing
• Standing
• Exercising
• Engaging in other physical activity

Exams and Tests

The health care provider will perform a physical exam, including a:

• Genital exam in men
• Pelvic exam in women
• Rectal exam

In some women, a pelvic examination may reveal that the bladder or urethra is bulging into the vaginal space.

Tests may include:

• Inspection of the inside of the bladder (cystoscopy)
• Pad test (after placement of a pre-weighed sanitary pad, the patient is asked to exercise -- following exercise, the pad is re-weighed to determine the amount of urine loss)
• Pelvic or abdominal ultrasound
• Post-void residual (PVR) to measure amount of urine left after urination
• Rarely, an electromyogram (EMG) is performed to study muscle activity in the urethra or pelvic floor
• Tests to measure pressure and urine flow (urodynamic studies)
• Urinalysis or urine culture to rule out urinary tract infection
• Urinary stress test (the patient is asked to stand with a full bladder, and then cough)
• X-rays with contrast dye of the kidneys and bladder

The health care provider may also measure the change in the angle of the urethra when at rest and when straining (Q-tip test). An angle change of greater than 30 degrees often means there is significant weakness of the muscles and tissues that support the bladder.

References

Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA. 2008;299:1446-1456.

Rogers RG. Clinical practice. Urinary stress incontinence in women. N Engl J Med. 2008;358:1029-1036.