Question

A 50 year old woman complains that she leaks a small amount of urine when she is coughing and sneezing , and during exercise .She has had 3 children. Describe the possible cause and type of urinary incontinence in this patient .

Answer 1

As the patient is female and is likely to have menopause and is multiparous, it likely that she has developed STRESS INCONTINENCE. Stress incontinence is leakage of urine when coughing, sneezing, exercising, etc. as these put pressure (stress) on the abdominal muscles, that further put pressure on bladder and leakage of urine occurs. This is not related to mental stress.

Risk factors:

• Female: it is more common in females.
• Multiparity: the females who have multiple children are more likely to develop stress incontinence.
• Types of delivery: females who got Cesarean section are at more risk.
• Age: Menopausal females have higher incidence as age decreases the muscular power.
• Smoking.
• Any pelvic surgery like hysterectomy.

Normally, when the bladder expands, the urethra remains closed to prevent leakage.

As after multiple child births, pelvic surgery, etc. the pelvic muscles and urinary sphincter are weakened, therefore when doing coughing, exercising, etc the pressure increases on the abdominal muscles which transmit the pressure to bladder wall muscles which contract strongly and due to weakness of urinary sphincter, urethra has to open. Therefore leakage occurs.