Stress urinary incontinence (SUI)

• Genuine stress incontinence (GSI)

• 623.9 Female stress urinary incontinence
• 788.30 Urinary incontinence, unspecified
• 788.34 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

• Pattern 4C: impaired muscle performance1

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 episode of intra-abdominal pressure

Essentials of Diagnosis

• Urinary stress test or cough test

General Considerations

• Consideration of lower urinary tract infections
  • Sudden onset of symptoms
  • Urinary frequency
  • Urinary urgency
  • Lower back pain
• Myogenic dysfunction of the detrusor

Demographics

• Urinary incontinence affects 30% to 60% of middle-aged and older women and 22% of men2-4
• Urinary incontinence reported by 78% of women with low back pain5
• Severe urinary incontinence is more prevalent in later years
• 30% to 52% of homebound elderly suffer from urinary incontinence6

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 or urge to urinate

Functional Implications

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

Possible Contributing Causes

• Underactive, overactive, or non-functioning pelvic floor muscles
• Pelvic organ prolapsed
• Urethral hypermobility
• Intrinsic sphincter deficiency
• Bladder cancer
• Bladder inflammation
• Bladder stones
• Benign Prostatic Hypertrophy (BPH)
• Comorbidities such as diabetes, stroke, hip replacement
• Urinary tract infections: bacterial
• Reduction of maximal urethral closure pressure

Differential Diagnosis

• Urinary tract infection (UTI)

Imaging

• Ultrasound imaging to identify abnormalities
  • Bladder
  • Urethra
  • Pelvis
  • Bladder neck position and mobility
  • Pelvic floor function
  • Activity of levator ani
  • Descent of pelvic organs
  • Sphincter integrity
• MRI to examine soft tissue structures of the pelvic support apparatus
• Pelvic/abdominal ultrasound
  • Measure bladder capacity
  • Rule out other pathologies

Diagnostic Procedures

• Rule out urinary tract infection (UTI)
• Post-void residual volume (PVR): measures amount of urine left after urinating
• Urodynamics: functional study of the lower urinary tract
  • Indications include: unclear cause of voiding dysfunction, incontinence unresponsive to conservative treatment, history of hysterectomy, bladder surgeries or pelvic organ prolapse procedures, neurological conditions
  • Assess sphincter competency
• Three incontinence questions (3IQ):
  • Sensitivity of .86
  • Specificity of .607
• Urethral pressure profile: study of intraluminal pressure along the length of the urethra via pressure sensitive catheter
• Leak point pressure profile: dynamic study of urethral pressure during activity
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