Treatment of Stress Urinary Incontinence in Women

A Medical and Surgical Review

Kristin Sanders, BSN, RN

Disclosures

Urol Nurs. 2019;39(1):29-35. 

In This Article

Assessment and Diagnosis

Research reveals that approximately 3% of healthcare providers question their patients about incontinence, and an estimated 25% to 50% of patients seek treatment for UI (Wiers & Keilman, 2017). It is important that healthcare providers begin to focus on the prevention, diagnosis, and treatment of UI due to its prevalence among women and negative impact on quality of life. The clinical assessment of UI should begin with a thorough problem-focused history, including symptoms, time of onset, and frequency (Abrams et al., 2013). Standardized questions and validated questionnaires are useful in identifying those with UI symptoms and determining the type of incontinence, its severity, and the impact on quality of life. A standardized question such as, "Do you sometimes leak urine when you cough or sneeze or when you exert yourself, such as when lifting a heavy object?" may be used to assess for SUI (Staskin et al., 2013). The ICS recommends the use of objective measures, such as a bladder diary, and subjective measures, including patient-reported outcomes, for both the initial measurement of symptoms and assessment of therapy impact (Staskin et al., 2013).

A comprehensive assessment has been identified as the most valuable means of diagnosing SUI and includes the surgical and obstetric history, review of medical conditions, list of medications, social history, family history, and physical examination (Staskin et al., 2013). During the physical examination, the examiner should focus strongly on the abdominal, pelvic, and neurological assessment. For the evaluation of a patient with the complaint of SUI, a cough stress test is the recommended diagnostic tool. In the lithotomy position, the visualization of urine loss in sync with a forceful cough confirms SUI diagnosis (Guralnick, Fritel, Tarcan, Espuna-Pons, & Rosier, 2018). Urodynamic studies are extensions to the basic examination and are recommended in those with recurrent or complicated incontinence involving pain, hematuria, recurrent infections, pelvic irradiation, significant voiding symptoms, radical pelvic surgery, or suspected fistula (Abrams et al., 2013; Bent & McBride, 2018).

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