Stress incontinence

Alternative names:

fallen bladder; loss of pelvic support; urinary incontinence

Symptoms:

• Sensation of bladder fullness.
• Increased urinary frequency or urgency.
• Perineal or vulvar discomfort; feeling of pressure or bulging in the vagina.
• Discomfort during intercourse.
• Loss of urine with coughing, sneezing, standing, or during physical activity
• Difficulty in initiating urine stream or inability to empty bladder completely.

Note: A wide variety of lower urinary tract symptoms or vaginal symptoms may be associated with stress incontinence.

Signs and tests:

Physical examination will include an abdominal and rectal exam, a genital exam in men, and a pelvic exam in women. A pelvic examination may detect cystocele or urethrocele (protrusion of the bladder or urethra into the vaginal space).

Tests include:

• Post void residual (PVR) to measure amount of urine left after urination.
• Urinalysis/urine culture to rule out urinary tract infection.
• Urinary stress test (the patient is asked to stand with a full bladder, and then cough).
• Pad test (after placement of a pre-weighed sanitary pad, patient asked to exercise; following exercise, the pad is re-weighed to determine the degree of urine loss).
• A pelvic or abdominal ultrasound.
• X-rays with contrast dye.
• Cystoscopy (inspection of the inside of the bladder).
• Urodynamic studies (tests to measure pressure and urine flow).
• An EMG (myogram) (rarely performed).

Other tests may include the measurement of 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 indicates significant weakness of the muscles and tendons that support the bladder.