Skip to Main Content




  • Genuine stress incontinence (GSI)




  • 623.9 Female stress urinary incontinence

  • 788.30 Urinary incontinence, unspecified

  • 788.32 Incontinence without sensory awareness

  • 788.39 Other urinary incontinence




  • N39.3 Stress incontinence (female) (male)

  • N39.42 Incontinence without sensory awareness

  • N39.49 Other specified urinary incontinence

  • R32 Unspecified urinary incontinence




  • 4C: Impaired Muscle Performance1



A 30-year-old woman had her third baby by vaginal delivery2 years ago. She has recently started exercising again. She used to run 5 miles, 3 days per week. She notices now that after running 1 mile she leaks urine and wets her underpants. The other day, she was laughing with her friend and wet her underpants. The worse symptom was last week when she leaked urine during intercourse with her husband.




  • Involuntary loss of urine control occurring during an increase in intra-abdominal pressure

  • Urinary sphincter muscles are not able to prevent urine flow during an episode of intra-abdominal pressure

Essentials of Diagnosis

  • Urinary stress test or “cough” test

General Considerations

  • Consideration of lower urinary tract infections (UTIs)

    • Sudden onset of symptoms

    • Urinary frequency

    • Urinary urgency

    • Lower back pain

  • Myogenic dysfunction of the detrusor

FIGURE 279-1

Diagnostic approach to the patient with urinary incontinence (UI). (From Henderson MC, Tierney LM, Smetana GW. The Patient History: AnEvidence-Based Approach to Differential Diagnosis. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location

  • Urinary incontinence affects 30% to 60% of middle-aged and older women and 22% of men.24

  • Urinary incontinence reported by 78% of women with low back pain.5

  • Severe urinary incontinence is more prevalent in later years.

  • 30% to 52% of homebound elderly suffer from urinary incontinence.6





  • Loss of urine without meaning to urinate during activities where there is an increase in intra-abdominal pressure (including sexual intercourse)

    • Coughing

    • Sneezing

    • Laughing

  • Loss of a small amount of urine preceded by an increase in intra-abdominal pressure but without a sensation of urge to urinate

Functional Implications

  • May lead to use of pads and/or wearing of diapers

Possible Contributing Causes

  • Underactive, overactive, or nonfunctioning pelvic floor muscles (PFMs)

  • Pelvic organ prolapse

  • Urethral hypermobility

  • Intrinsic sphincter deficiency

  • Bladder cancer

  • Bladder inflammation

  • Bladder stones

  • Benign prostatic hypertrophy (BPH)

  • Comorbidities such as diabetes, stroke, hip replacement

  • UTIs: Bacterial

  • Reduction of maximal urethral closure pressure

Differential Diagnosis

  • Spinal cord injury


Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.