Stress urinary incontinence

Question 1

What is the definition of stress urinary incontinence?

Answer 1

involuntary leakage of urine during times of increased intra abdominal pressure
‘Pure SUI’ indicates the absence of over active bladder

Question 2

What is the most common mechanism of SUI (pathophysiology)

Answer 2

• urethral hyper-mobility
• deficient pub-urethral ligament usually due to weak pelvic floor muscles
• the urethra and bladder neck can’t close against the anterior vaginal wall

‘like stepping on a hose on the sand rather than on concrete’

Question 2

What is the most common mechanism of SUI (pathophysiology)

Answer 2

• urethral hyper-mobility
• deficient pub-urethral ligament usually due to weak pelvic floor muscles
• the urethra and bladder neck can’t close against the anterior vaginal wall

‘like stepping on a hose on the sand rather than on concrete’

Question 3

List 4 causes of urethral hyper-mobility

Answer 3

• Chronic cough
• obesity
• high impact sport
• trauma from childbirth (to muscles and nerves)

Question 4

List the less common mechanism of SUI

Answer 4

intrinsic sphincter deficiency

- loss of intrinsic urethral mucosal or muscular tone resulting in a weak sphincter with low urethral closing pressures

Question 5

What is the cause of intrinsic sphincter deficiency?

Answer 5

neuromuscular damage:

• multiple pelvic or incontinence surgeries
• age
• radiation

Question 6

How do you treat intrinsic urethral sphincter deficiency?

Answer 6

• improve urethral blood flow with estrogen and pelvic floor exercises

Question 7

What physio input should you recommend for women with SUI (or any other incontinence)

Answer 7

• Pelvic floor muscle training
• first-line management
• supervised, for at least 3 months
• 8 contractions 3x a day

Question 8

List 2 medical management options for SUI

Answer 8

• vaginal estrogen

- duloxetine (SNRI)

Question 9

What is Duloxetine and how does it work for SUI?

Answer 9

SNRI

thought to increase pudendal nerve activity increasing urethral sphincter closure

Question 10

What are 3 side effects of duloxetine?

Answer 10

• dry mouth
• nausea
• constipation

Question 11

List 4 characteristics of a perfect candidate for surgical intervention for SUI

Answer 11

• completed family
• pure urodynamic stress incontinence
• normal BMI
• no significant medical comorbidity

Question 12

List 4 factors that would make pre-op for SUI surgical candidate perfect?

Answer 12

• completed bladder diary
• completed PFMT exercises for minimum 3 months
• compliant with conservative measures including lifestyle changes
• realistic expectations for outcomes