Stress incontinence is best treated by
a. Most common cause of leakage of urine in women is Genuine stress incontinence (GSI)
b. Occurs secondary to weakness of distal sphincter mechanism associated with laxity of pelvic floor
c. Usually seen in multiparous women with h/o difficult labour (forceps). Can be found in young women who indulge in competitive tramp lining.
d. Symptoms- urine loss during coughing, sneezing, laughing or sudden change of posture. Frequency and urgency occur due to frequent voiding as the patients try to avoid incontinence.
e. Test- Exercise test with 300ml of fluid in the bladder- In GSI fluid loss range from 10-50ml
f. D/D- Idiopathic detrusor instability (Urodynamic studies)
Rx of Stress Incontinence-
i. Minor degree- Pelvic floor exercise
ii. If exercise fails then surgery- Gold standard Rx is BURCH COLPOSUSPENSION (Bladder neck suspension)
iii. Stamey’s modification of colposuspension
iv. Tension free vaginal tape (TVT)- Recent