This type of incontinence may be caused by many conditions. Overflow incontinence. When a bladder does not fully empty, patients may have frequent urination or constant dribbling of urine.
Lack of mobility. Mixed incontinence is a combination of more than one type of the above. Although incontinence may have numerous causes, the following are common reasons why you or your loved one may have stress incontinence: Childbirth. During childbirth, tissue and nerve damage may occur during the delivery of an infant. Damage to these tissues and nerves may create weak pelvic floor muscles and can begin incontinence soon after delivery or years later.
Prostate surgery. The most common factor for male stress incontinence is the surgical removal of the prostate gland to treat prostate cancer. This procedure may weaken the sphincter. Hysterectomy surgery. This creates a perfect scenario to develop stress incontinence.
Individuals who are obese are at a higher risk for stress incontinence. While urinating he sneezed which was accompanied by lancinating perineal pain that was short-lived, and he was able to complete micturition normally. There was no haematuria or urethral bleeding noted. Three days later he developed terminal haematuria and sought medical attention. When seen, he denied having any flu-like symptoms or urethral discharge.
He appeared unwell and had a fever of His mucous membranes were pink and moist and the general physical examination was normal. The abdominal examination was normal and he had no renal angle or suprapubic tenderness. Examination of the genitalia was normal except for tenderness in the perineum.
Digital rectal examination DRE revealed a tender boggy prostate. The serum prostate-specific antigen PSA was 9. He complained of ejaculatory discomfort and heightened perineal sensation when sitting for long periods. On examination he had perineal tenderness on deep palpation. His temperature was Repeat DRE demonstrated a small nontender prostate of normal consistency.
Repeat urinalysis was normal and PSA returned at 1. After four-month follow-up the patient has remained free of any new-onset storage or voiding lower urinary tract symptoms LUTS , denies having any ejaculatory or postejaculatory pain or discomfort, has no perineal or pelvic pain or discomfort, and appears to be completely devoid of any long term sequelae.
Repeat PSA 4-months after initial presentation is now 0. When sneezing occurs during bladder storage there is an abrupt increase in the urethral closure pressure due to increased efferent somatic motor activity in the pudendal nerves causing contraction of the external urethral sphincter EUS and levator ani muscles, thereby preventing urinary incontinence [ 2 , 3 ].
However, during voiding there is normally relaxation of the EUS, the pelvic floor, and bladder neck immediately prior to and throughout voiding until it is completed [ 4 ]. When the patient sneezed during voiding his bladder outlet and pelvic floor would have initially been in an open and relaxed state. It is theorized that the sneeze reflex would have overridden the voiding reflexes, due to the integration of these reflexes by the periaqueductal grey in the brainstem [ 5 ].
This would have resulted in reflex contraction of the EUS and pelvic floor causing an abrupt obstruction to urine flow during voiding. Simultaneous with this abrupt urethral obstruction would have been a precipitous increase in intravesical pressure Pves arising from the transmission of the sudden increase in intra-abdominal pressure IAP , due to sneezing, to the already contracting urinary bladder.
It is not known whether the bladder neck would have simultaneously closed with the EUS, but whether it remained open or not during sneezing, an abrupt and severe pressure-head in the urine-filled prostatic urethra upstream of the contracted EUS would have been generated. The abruptly increased pressure head in the urine-filled prostatic urethra would have driven urine into the prostatic ducts that open directly into the prostatic urethra [ 6 , 7 ]. The more horizontally oriented ducts draining the posterior zone of the prostate [ 8 ] would have encountered potentially greater intraprostatic urinary influx and possible denudation of the epithelial cells lining the ducts and acini from the shearing force of the urine gushing into them under high pressure.
Along with this more formal training, at-home Kegel exercises can also help strengthen the pelvic floor muscles. This procedure involves injecting a bulking substance, such as collagen, around the urethra to either close a hole or build thickness in the urethral wall.
This added thickness helps the urethra withstand extra pressure from physical activity. As a result, this procedure is used less often and is usually reserved for older patients. Do you need to see a urogynecologist? Find one near you. November 15, Gynecology , Urology , Women's Health.
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