urinary stress incontinence

see also:

• urinary urgency and urge incontinence
• urinary incontinence
• https://www.racgp.org.au/afp/2017/september/adult-male-stress-and-urge-urinary-incontinence/

• involuntary loss of control of urine is a common problem and if it is recurrent becomes a major impact on a person's life and socialisation
• urinary continence requires:
  • a functional autonomic bladder sphincter
  • a functional voluntary sphincter
    • this not only relies upon neural inputs but pelvic floor muscle tone and control

• post-TURP
• sphincter injury - pelvic fractures, iatrogenic from surgery, radiation therapy, obstetric injury /mutiple vaginal deliveries
• vascular disease
• pelvic floor insufficiency, age, obesity, frailty

• avoid or reduce:
  • chronic coughs - cease smoking (nicotine itself can increase incontinence)
  • exertion / heavy lifting
  • excessive caffeine
  • alcohol
  • obesity
  • straining - constipation Mx
  • hormonal deficiencies (eg. oestrogen replacement Rx])
  • overly full bladder - timed voids, avoid excessive fluid intake
• pelvic floor muscle training
• consider trial of pseudoephedrine
• consider surgical treatments such as urethral slings