1. Stress Urinary Incontinence Dr. Ali Abd El-Monsif Thabet

2. Types of female urinary Incontinence True incontinence True incontinence Urge incontinence Urge incontinence False incontinence (retention with over flow) False incontinence (retention with over flow) Nocturnal enuresis Nocturnal enuresis

3. Stress incontinence It is involuntary leakage of urine, from the urethra and such leakage occurs on sudden rise of intraabdominal pressure, as in coughing, laughing, sneezing, straining, or any other physical activities, when the intravesical pressure exceeds the maximum urethral pressure in the absence of detrusor contraction. It is involuntary leakage of urine, from the urethra and such leakage occurs on sudden rise of intraabdominal pressure, as in coughing, laughing, sneezing, straining, or any other physical activities, when the intravesical pressure exceeds the maximum urethral pressure in the absence of detrusor contraction.

4. Psychological impact It has a profound psychosocial impact not only on patients but also on their families and caregivers, resulting in It has a profound psychosocial impact not only on patients but also on their families and caregivers, resulting in

5. Pathophysiology of stress incontinence Pathophysiology of stress incontinence

6. The effect of intra-abdominal pressure on the urethra: (a) normal (B) bladder neck descended

7. Grades of stress incontinence Grades of stress incontinence Grade I. Incontinence only with severe stress, such as coughing, sneezing, or jogging Grade I. Incontinence only with severe stress, such as coughing, sneezing, or jogging Grade II. Incontinence with moderate stress, such as rapid movement or walking up and down stairs. Grade II. Incontinence with moderate stress, such as rapid movement or walking up and down stairs. Grade III : Incontinence with mild stress, such as standing. The patient is continent in the supine position. Grade III : Incontinence with mild stress, such as standing. The patient is continent in the supine position.

8. Incidence of stress incontinence

9. Aetiology 1.Congenital 1.Congenital 2. Traumatic 2. Traumatic 3. Hormonal dysfunction 3. Hormonal dysfunction 4. Infections 4. Infections

10. Factors that provoke or aggravate incontinence Excess body weight Excess body weight Chronic coughing Chronic coughing Smoking Smoking Drugs Drugs

11. Evaluation Diagnostic Tests Stress Test Stress Test Bonney's test Bonney's test One-Hour office Pad Test One-Hour office Pad Test Perineometer Perineometer Electromyography Electromyography

12. Treatment 1. Prophylaxis 1. Prophylaxis 2. Curative Treatment 2. Curative Treatment

13. Surgical Treatment Collagen injection Collagen injection Sling operations Sling operations Artificial sphincters Artificial sphincters

14. Physiotherapy For Pre and Post operative cases Pre-operative education Pre-operative education 1- Breathing exercises 1- Breathing exercises 2- Circulatory exercises 2- Circulatory exercises 3- Pelvic floor exercises 3- Pelvic floor exercises 4- Abdominal exercises 4- Abdominal exercises 5- Postural education. 5- Postural education.

15. Urge incontinence By using acute maximal stimulation through a vaginal and an anal electrode with current frequency from 5-10 Hz for 20 minutes. The current intensity varied from 5-80 mA on the rectal electrode and from 15-100 mA on the vaginal electrode. For 6 to 14 treatments are given with 2-3 sessions a week. By using acute maximal stimulation through a vaginal and an anal electrode with current frequency from 5-10 Hz for 20 minutes. The current intensity varied from 5-80 mA on the rectal electrode and from 15-100 mA on the vaginal electrode. For 6 to 14 treatments are given with 2-3 sessions a week. The maximal electrical stimulation may inhibit spontaneous detrusor contractions by normalizing the disturbed balance between cholinergic and adrenergic neurotransmission. The maximal electrical stimulation may inhibit spontaneous detrusor contractions by normalizing the disturbed balance between cholinergic and adrenergic neurotransmission.

16. Thank you