Six Types of UI: Assess & Manage

2. STRESS

DEFINITION: Urethral sphincter failure, usually associated with increased intraabdominal pressure.

PATHOPHYSIOLOGY:

• Urethral hypermobility due to anatomical changes such as weakened pelvic floor muscles, or defects such as fascial detachments.
• Etiology may be childbirth, low estrogen, obesity, recent urinary catheterization, or surgery.
• Intrinsic urethral deficiency (ISD) failure at rest. ISD failure is an unusual complication that results in a continuous leaking of urine

SIGNS & SYMPTOMS:

A small amount of urine lost during physical activities that cause increased intraabdominal pressure, such as walking, bending, coughing, or sneezing.

CHARACTERISTIC FINDINGS of uncompicated Stress incontinence

Normal PVR, no complications.

MANAGEMENT OPTIONS

• Behavioral
  • Pelvic muscle exercise
  • Biofeedback
  • Vaginal weight training with cones
  • Pelvic floor electrical stimulation
  • Bladder training, usually scheduled voiding.
• Pharmacologic
  • Estrogen may be prescribed on an individual basis. There is controversy regarding its efficacy and risks.
• Complicated stress incontinence needs referral to urologist, and may require surgery.

Various surgical options are discussed at this site by Greater Carolinas Women's Center (Boesel, MD)

Instant Feedback:

©2006 RnCeus.com