Ease Into Prep with a PANCE^® Question of the Day

The correct answer is D. Stress incontinence is an involuntary loss of bladder function. Often the precipitating events for stress incontinence involve activities that increase intra-abdominal pressure, such as laughing or coughing. Valsalva-type maneuvers, such as weightlifting, are notorious for causing stress incontinence. This condition is seen in women, and its incidence increases with age. It is treated conservatively with pelvic floor exercises (Kegel maneuvers) that strengthen the musculature of the bladder outlet. Other modalities that can be used include medications (alpha-agonists, estrogen), behavioral therapy (biofeedback), and surgery (bladder neck suspension).

Oral contraceptive pills (choice A) are not commonly associated with incontinence, and this is the only "drug" that she is taking.

Functional incontinence (choice B) usually occurs in association with psychological unwillingness or pathology, physical impairment (i.e., mobility), or physical barriers that may deter a person from using the bathroom. A classic example of a functionally incontinent person is a patient who has severe dementia who has a primary neurologic process that does not allow her to discriminate when she should or should not void. Therapy involves behavioral therapies and devices that aid in control of incontinence (e.g., pads, catheters).

Overflow incontinence (choice C) is a result of detrusor sphincter dyssynergy or anatomic abnormalities that allow for passage of urine. Examples of such physical abnormalities include prostatic hypertrophy and multiple uterine leiomyomata. Those persons who tend to have overfilled bladders resulting in this condition include diabetic patients who have atonic bladders (neurogenic bladder) and paraplegic patients, to name a few. Treatment involves surgery and/or catheterization.

Urge incontinence (choice E) involves loss of large volumes of urine because the body does not sense that the bladder is full. When the patient does get the urge to go, release of urine is almost instantaneous. This is usually secondary to bladder muscle instability or insensitivity. Patients who have neurologic disorders are particularly prone to this type of incontinence.

PEARL: Stress incontinence is caused by relaxed pelvic floor musculature. It is characterized as urine leaking out of the bladder, through the urethra, resulting in wetting oneself during times of increased intra-abdominal pressure (e.g., coughing, laughing, sneezing, or lifting). Treatment is strengthening the pelvic musculature via Kegel maneuvers, medication (alpha-agonist), or surgery (bladder neck suspension).