A 40 year old multiparous women complains of involuntary loss of urine associated with coughing, laughing, lifting weight or standing. The history is most likely suggestive of: (A) Fistula, (B) Stress incontinence, (C) Urge incontinence, (D) Urethral diveiculum
Answer is B. Stress incontinence When the woman voids a small quantity of urine involuntarily while sneezing, coughing or laughing. The condition also develops during pregnancy and soon after delivery There is no desire to pass urine, but dribbles a small quantity on stress Grading: Grade 0:Incontinence without leakage Grade I: Incontinence caused only with severe stress such as coughing , sneezing and jogging Grade II: Incontinence caused by moderate stress such as fast walk,going up and down the stairs Grade III: Incontinence caused by mild stress such as standing Other options Fistula: a fistula is a communication between two cavities, such as vesico-vaginal fistula, urethrovaginal, uretero-vaginal fistulas. These fistulas have will present with incontinence, unrelated to activity or raised intra-abdominal pressure Urge incontinence :associated with sudden and abrupt desire to void. It is associated with detrusor instability (overactive bladder) or detrusor hyperreflexia secondary to neurological disease Overflow incontinence: leakage of small amount of urine resulting from mechanical forces on overdistended bladder