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279: STRESS URINARY INCONTINENCE

Cynthia E. Neville, DPT, PT, WCS

CONDITION/DISORDER SYNONYM

  • Genuine stress incontinence (GSI)

ICD-9-CM CODES

  • 623.9 Female stress urinary incontinence

  • 788.30 Urinary incontinence, unspecified

  • 788.32 Incontinence without sensory awareness

  • 788.39 Other urinary incontinence

ICD-10-CM CODES

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

  • N39.42 Incontinence without sensory awareness

  • N39.49 Other specified urinary incontinence

  • R32 Unspecified urinary incontinence

PREFERRED PRACTICE PATTERN

  • 4C: Impaired Muscle Performance1

PATIENT PRESENTATION

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.

KEY FEATURES

Description

  • 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. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Demographics

  • Urinary incontinence affects 30% to 60% of middle-aged and older women and 22% of men.2–4

  • 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

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • 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

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