Stress Urinary Incontinence

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Stress Urinary Incontinence

• Dr. Ali Abd El-Monsif Thabet

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Types of female urinary Incontinence

• True incontinence
• Urge incontinence
• False incontinence (retention with over flow)
• Nocturnal enuresis

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Stress incontinence

• It is involuntary leakage of urine, from the
  urethra and such leakage occurs on sudden rise of
  intraabdominal pressure, as in coughing,
  laughing, sneezing, straining, or any other
  physical activities, when the intravesical
  pressure exceeds the maximum urethral pressure in
  the absence of detrusor contraction.

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Psychological impact

• It has a profound psychosocial impact not only on
  patients but also on their families and
  caregivers, resulting in

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• Pathophysiology of stress incontinence

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The effect of intra-abdominal pressure on the
urethra (a) normal (B) bladder neck descended
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Grades of stress incontinence

• Grade I. Incontinence only with severe stress,
  such as coughing, sneezing, or jogging
• Grade II. Incontinence with moderate stress,
  such as rapid movement or walking up and down
  stairs.
• Grade III Incontinence with mild stress, such
  as standing. The patient is continent in the
  supine position.

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• Incidence of stress incontinence

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Aetiology

• 1. Congenital
• 2. Traumatic
• 3. Hormonal dysfunction
• 4. Infections

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Factors that provoke or aggravate incontinence

• Excess body weight
• Chronic coughing
• Smoking
• Drugs

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Evaluation

• Diagnostic Tests
• Stress Test
• Bonney's test
• One-Hour office Pad Test
• Perineometer
• Electromyography

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Treatment

• 1. Prophylaxis
• 2. Curative Treatment

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Surgical Treatment

• Collagen injection
• Sling operations
• Artificial sphincters

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Physiotherapy For Pre and Post operative cases

• Pre-operative education
• 1- Breathing exercises
• 2- Circulatory exercises
• 3- Pelvic floor exercises
• 4- Abdominal exercises
• 5- Postural education .

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Urge incontinence

• By using acute maximal stimulation through a
  vaginal and an anal electrode with current
  frequency from 5-10 Hz for 20 minutes. The
  current intensity varied from 5-80 mA on the
  rectal electrode and from 15-100 mA on the
  vaginal electrode. For 6 to 14 treatments are
  given with 2-3 sessions a week.
• The maximal electrical stimulation may inhibit
  spontaneous detrusor contractions by normalizing
  the disturbed balance between cholinergic and
  adrenergic neurotransmission.

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Thank you