PREVALENCE, RISK FACTOR, PATHOPHISIOLOGY OF SUI

Dr. Budi Iman Santoso, SpOG(K)

Division of Urogynecology ReconstructiveDepartment of Obstetrics and GynecologyFaculty of Medicine University of Indonesia

Jakarta

INTRODUCTION

If we can identify women at risk of urinary incontinence, then perhaps early intervention can reduce stress in some of themIf physical stressors such as vaginal childbirth, vigorous exercise, massive obesity, and vaginal hysterectomy are risk factor for stress urinary incontinence (SUI), then either avoidence of stressors or preemptive strengthening exercises may prevent urinary leakage.There areanecdotal reports of female astronouts returning from a reduced-gravity environment to be greeted by SUIThis seems to higlight the importance of maintaining tone in the pelvic floor

Table 1Table 1RISK FACTORS FOR URINARY RISK FACTORS FOR URINARY INCONTINENCE IN WOMENINCONTINENCE IN WOMEN

PREDISPOSING FACTORS PROMOTING FACTOR Gender Genetics Race Culture Neurology Anatomy Collagen status

Bowel dysfunction Dietary irritants Activity level Obesity Menopause Infection Medicine Pulmonary status Psycharic status

INCITING FACTORS DECOMPENSATING FACTORS Childbirth Surgery Pelvic nerve or muscle

damage Radiation

Aging (DIAPPERS)

Adapted from urology 1997;50’15-16

The prevalence of incontinence is 37% in the United states, 26% in continental Europe, and 29% in the United Kingdom. Combining series from Singapure, Pakistan, Tunisia, NewZeland, and Japan yields a mean prevalence of incontinence of 20% according to the literature

PREVALENCE:

Fig 1. Factors contributing to the female continence mechanism under resting and stress conditions. (From Walters MD, Jackson GM: J Reprod Med 35:779, 1990.)

urethral supportintraabdominal pressure variation

(obesity, respiratory disease)Passive

intraabdominal

urethral supportageparityestrogen status

ActiveNeuromuscular

Stress

ageparity

Estrogen status

Intrinsic Smooth Muscle

+Extrinsic

Skeletal Muscle+

Vascular/ElasticTissue

Resting

Intraurethral

Pressure

(pressure transmission)

Stress Response

CONTINENCE

Fig 2. Proposed mechanisms of urethral pressureaugmentation with increases in intraabdominal pressure. (Redrawn from Walters MD: Obstet Gynecol Clin North Am 16:773,1989.)

Fig 3. Anatomic alterations in position of the bladder and urethra with genuine stress incontinence and an estimation of the relative transmission of intraabdominal pressure to the bladder and urethra. Worsening severity of anatomic displacement of the urethrovesical junction results in decreased pressure transmission of intraabdominal pressure to the urethracompared with the bladder.

DETERMINANTSOF

STRESS CONTINENCE

Stress pressure

transmisionResting urethral closure pressure

Intraabdominal pressure increases

Fig 4.Determinants of stress incontinence. If themagnitude of the bladder pressure Increase generatedby the stress times the inefficiency of pressure transmission [1-(∆Pu/∆PB)] exceeds the urethral closure pressure, genuine stress Incontinence results. (FromBump RC: Obstet Gynecol Clin North Am 16:795,1989.)

CONCLUSION1

Defining risk factor for urinary incontinence in women is essintial to institute preventive or corrective measures. While presdisposing risk factors are predetermined, inciting, promoting, or decompensating risk factors may be avoided or treated to improve continence status.

CONCLUSION2

Unfortunately, the pathophysiology of incontinence associated with particular risk factor is poorly understood. In addition, well-designed studies employing preventive or corective measure to deal with incontinence are rare. Increased research into the rule of risk factors for urinary incontinence in women is needed to help the many women effected