Stress Incontinence (Decreased Resistance)

Your Path

  • Stress incontinence (Decreased resistance)


  • Decrease/impaired resistance at level of bladder neck such that any increase in abdominal pressure (e.g. w/coughing) causes leakage of urine
  • Caused by urethral hypermobility, due to decreased support from pelvic floor muscles and connective tissue → urethra and bladder neck cant close in response to increased intra-abdominal pressure
  • Also contribution from loss of urethral muocsa and muscular tone → decresed urethral closure
  • Direct damage to sphincter during GU surgery (men)

Risk Factors

  • Women >> men
  • Increased age (> 40 yo in women)
  • Women: pregnancy, vaginal childbirth, elevated BMI
  • Men: complication of prostatectomy → damaged external sphincter in men


  • Incontinence with cough, sneeze, excercise, sudden movement → sudden increase in intra-abdominal pressure
  • Amount of urine lost varies based on severity of problem; typically small amounts at onset of symptoms
  • Night time symptoms are uncommon
  • Important to understand how bothersome symptoms are/impact on quality of life to the individual patient
  • Can quantify by asking whether use pads to capture urine, soaked v small amount of wetness, frequency with which they're changed

Physical Exam Findings

  • Incontinence may be reproduced if cough when in stirrups
  • Sometimes prolapsed bladder or uterus evident
  • Also note whether mucosal atrophy