Female stress urinary incontinence

doi:10.1136/bmj.b5533

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Rebecca Daniel, National Institute for Health Research general practice clinical academic fellow1,
Christian David Mallen, senior lecturer in general practice1,
Jason Cooper, consultant urogynaecologist2

¹Arthritis Research Campaign National Primary Care Centre, Keele University, Keele, Staffordshire ST5 5BG
²University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent ST4 6QG

Correspondence to: Rebecca Daniel r.daniel{at}cphc.keele.ac.uk

Accepted 9 September 2009

A 55 year old postmenopausal woman presents with episodes of leaking urine exacerbated by coughing and exercise. She has had three vaginal deliveries, two of which were instrumental. Her symptoms have worsened since menopause and she often has to wear a pad.

What issues you should cover

Female urinary incontinence is common and increases with age. Prevalence ranges from 10% to 50% but fewer than half of affected women consult primary care.

A clear history of symptoms and a good obstetric and gynaecological history are essential, as is a history of bowel habits, as constipation can be associated with stress incontinence. Differentiating between stress and urge incontinence is important as they often exist together and treatment options differ. Elicit a medication history—α blockers and diuretics could worsen symptoms—and a smoking history.

Although urinary incontinence can occur in nulliparous women, risk factors include pregnancy, childbirth, age, obesity (BMI >30), and postmenopausal status. Prolonged labour and instrumentation increase the chance of incontinence in later life. Prolapse and prolapse surgery are often associated with urinary incontinence.

Symptoms include leakage of urine with activities that increase intra-abdominal pressure, such as laughing, coughing, and sneezing. In …