Stress urinary incontinence

Stress Urinary Incontinence is a type of urinary incontinence in which leakage occurs without detrusor contraction with a simple increased intra-abdominal pressure (i.e., stress). The cause is insufficient function of the closing mechanism of the urethra. When intra-abdominal pressure increases, the urethra is not pathologically compressed (normal mechanism), but instead the urethra moves freely (hypermobility) and the pressure pushes urine through the bladder wall into the urethra.

Causes
The most common mechanisms of formation are two :


 * change in the position of the pelvic organs,
 * intrinsic sphincter defect.

The most common causes of these conditions are birth trauma, obesity, congenital connective tissue disorders, insufficient involvement of the pelvic floor muscles (e.g. standing up from a sitting position with crossed legs). The cause of the increase in intra-abdominal pressure causing urine leakage itself is chronic cough, heavy physical work, constipation.

Change in the position of the pelvic organs
A functional urethral closure mechanism and good anatomic support of the proximal urethra, urethrovesical junction, and bladder base are needed to maintain continence. In women, a so-called paravaginal defect occurs. This is a detachment of the pubocervical fascia (endopelvic fascia) from the arcus tendineus fasciae pelvis. The vagina ceases to support the bladder and proximal urethra, and the bladder bulges into the vagina on the sides in the form of a  traction cystocele. In the event of a rupture of the endopelvic fascia itself, the bladder bulges centrally into the vagina and a pulse cystocele is formed.

Bladder neck hypermobility and resulting stress incontinence can sometimes be the result of pelvic operations, such as improperly performed hysterectomy, after which the bladder loses the support of the uterus.

Intrinsic sphincter defect
It occurs after menopause as a result of estrogen deficiency and is manifested by a decrease in the closing pressure in the urethra.

Related articles

 * Overactive bladder
 * Urinary incontinence
 * Nocturia
 * Polishuria
 * Radiodiagnostic examination of the urinary tract
 * Urgent urinary incontinence