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ACOG Releases New Guidelines for Stress Incontinence

May 29, 2014 2 min read

Stress urinary incontinence (SUI) in women is common. Those affected experience involuntary urinary leakage when exerting pressure onto their bladder, such as while coughing, laughing or lifting heavy objects. Treatments vary, with one of them being surgical repair with a midurethral sling.

A committee from the American College of Obstetricians and Gynecologists (ACOG) has released new guidelines for evaluating uncomplicated SUI before being recommended for surgery. The following guidelines were published in the June 2014 issue of Obstetrics & Gynecology:

  1. Obtain medical history. This includes history related to urological behaviors and symptoms, medical and neurological, and medications. Specialists should ask about the type of urinary incontinence experienced, how often leakage occurs, how often pads are used and how the symptoms affect daily living. Patients will be evaluated using validated questionnaires, such as the Incontinence-Quality of Life Questionnaire (I-QoL) and Incontinence Severity Index (ISI).
  2. Perform urinalysis to exclude urinary tract infections (UTIs). One of the common causes of incontinence is a UTI. The patient should be analyzed and treated for any UTIs. If the urinalysis results come back negative, the patient’s condition is consistent with uncomplicated SUI.
  3. Perform a physical examination. The main goal of the physical exam is to find any confounding or contributing factors that can be causing bladder leakage. These factors may include fistulas and pelvic organ prolapse (POP).
  4. Demonstrate stress incontinence using the cough test. The cough test is designed to physically see if there’s any fluid loss from the urethra while coughing. Patients should arrive with a full bladder.
  5. Evaluate urethral mobility. According to the ACOG, surgical treatment for incontinence is more successful in women with urethral mobility. This is defined as a “30 degree or greater displacement from the horizontal when the patient is in a supine lithotomy position and straining. The presence of urethral mobility indicates uncomplicated SUI.” Evaluation can be done via the cotton swab test, pelvic organ prolapse quantification system, and ultrasonography.
  6. Measure post-void residual urine volume. – This test measures the amount of urine left in your bladder after you urinate. Individuals with a post-void residual urine volume of less than 150 mL met the definition of uncomplicated SUI. A higher residual urine volume can indicate a bladder-emptying problem or incontinence associated with chronic urinary retention.

Surgery for treating incontinence should always be a last resort. If you are experiencing bladder leakage, be sure to contact your doctor to determine the cause. Nonsurgical treatments for incontinence include bladder retraining, pelvic floor exercises, and medication.


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