Stress urinary incontinence
last edited January 2018
Petros Sountoulidis, PhD, FEBU
Consultant Urologist, The Pennine Acute Hospitals NHS, Manchester, U.K

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Current ICS Definition


Stress urinary incontinence (SUI) is defined by the International Continence Society (ICS) as “the complaint of any involuntary loss of urine on effort or physical exertion (e.g sporting activities) or on sneezing or coughing” [1]. This is the type of incontinence most commonly reported by patients with chronic chest conditions.
Urinary incontinence is the unintentional, accidental, loss of urine. Stress incontinence is the type of involuntary loss of urine that happens during physical movement or activity (for instance coughing, sneezing, laughing, standing up or running, heavy lifting), conditions that elevate the abdominal pressure (stress) on the bladder. Stress incontinence is certainly not related to psychological stress.
Stress incontinence differs from urge incontinence, which is the unintentional loss of urine caused by the bladder muscle contracting, usually associated with a sense of urgency. Stress incontinence is more common in women of young to middle age. Stress incontinence is uncommon in men who have not had prostate surgery.

Old definitions
The definition of this type of incontinence was not modified in 2002 when the ICS standardization subcommittee reviewed the definitions of LUTS [2]. The committee however acknowledged that the term ‘‘activity-related incontinence’’ might express more accurately the exact nature of the condition. For reasons that are described below the term “stress incontinence” remained unchanged.
Perspectives and controversies
“Stress incontinence” is generally considered a suboptimal term to describe the condition of involuntary leakage of urine on physical effort or exercise, coughing, sneezing and lifting. The main disadvantage of the terms is that it can be easily confused, especially in the English language, to incontinence associated to or precipitated by psychological stress.
To capture the exact nature of the condition, the expression “effort incontinence” was deemed more preferable by many. Apparently the terms “incontinence of effort”, “effort incontinence” and “orthostatic incontinence” had been used to describe the condition in French, Italian, Spanish and Polish publications from the late 50s until the late 70s when the term stress incontinence eventually prevailed [3,4,5]. The term “stress incontinence” had been however in use in the English literature since the mid 40’s [6].
The term “stress incontinence” is meant to describe the condition of involuntary leakage of urine caused by somatic stress (lifting, coughing, laughing, sneezing etc). Undoubtedly the term is suboptimal as it implies an element of psychological distress, which is certainly not a cause of the condition. On the other hand the term “effort incontinence” does not capture some of the common involuntary triggering factors for stress incontinence such as coughing or sneezing.
A term that might cover most, if not all, of the aspects of this condition might be “activity-related incontinence” although again there is overlapping with urge incontinence that is also often precipitated by activity such as hand washing.

References




  1. 1. Haylen BT et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction. Neurourol Urodyn 2010; 29:4–20
  2. 2. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003 Jan;61(1):37-49.
    1. 3. Dzieszko W.[Results of operative management in cases of effort urinary incontinence in women].Ginekol Pol. 1957 May-Jun;28(3):261-9. Polish. No abstract available.
    2. 4. Truc E. [Treatment of urinary incontinence due to sphincteric insufficiency (effort insufficiency or orthostatic incontinence)].J Urol Nephrol (Paris). 1961 Apr-May;67:304-8. French.
      1. 5. Bruno CA. [Urinary incontinence of effort. Contribution to the study of the pathogenesis].Ann Ostet Ginecol Med Perinat. 1968 Nov;90(11):776-88.
      2. 6. Reich WJ, Wilkey JL, Silverman HE. Urinary stress incontinence in the female; a combined gyno-urological approach to its correction.Am J Surg. 1945 Dec;70:341-53.

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