Question

An elderly female presented with dribbling of urine only on coughing and straining. What type of urinary incontinence is she suffering from?

• A. Stress incontinence
• B. Urge incontinence
• C. Overflow incontinence
• D. Neurogenic bladder

Hint:

Consider which type of incontinence is triggered by a sudden rise in intra-abdominal pressure rather than bladder urgency.

Answer 1

The Correct Option is A

Step 1: Define the clinical scenario.
The patient is an elderly female who leaks urine specifically when coughing or straining. There is no mention of sudden urge to urinate or inability to empty the bladder.

Step 2: Review types of urinary incontinence.
- Stress Incontinence: Leakage of urine with sudden increases in intra-abdominal pressure (coughing, sneezing, straining, laughing). Caused by weakness or laxity of the pelvic floor muscles and urethral sphincter. Most common in elderly women (post-menopausal) and multiparous women.
- Urge Incontinence: Leakage preceded by a strong, sudden urge to urinate. Associated with detrusor overactivity (overactive bladder).
- Overflow Incontinence: Constant dribbling from an over-distended, poorly emptying bladder; associated with urethral obstruction or detrusor underactivity.
- Neurogenic Bladder: Bladder dysfunction due to neurological disease; can be flaccid (lower motor neuron) or spastic (upper motor neuron).

Step 3: Match the presentation.
Dribbling only on coughing and straining, without urgency, fits Stress Incontinence. During coughing, intra-abdominal pressure rises acutely. With weakened pelvic floor muscles, this pressure is transmitted to the bladder without being equally transmitted to the urethra, causing urine to leak.

Conclusion: Stress incontinence.