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
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
Fistula
Stress incontinence
Urge incontinence
Urethral diveiculum
Genital Prolapse - various presentation of prolapse and management of urinary stress incontinence (I am hanging by my nails !)