Stress Incontinence in Women

Wu, Jennifer M. M.D., M.P.H.

From the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill.

Caren G. Solomon, M.D., M.P.H., Editor

Address reprint requests to Dr. Wu at the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 4030 Bondurant Hall, Campus Box #7000, Chapel Hill, NC 27599-7570, or at [email protected].

Dr. Wu reports receiving grant support from Boston Scientific. No other potential conflict of interest relevant to this article was reported.

Disclosure forms provided by the author are available with the full text of this article at NEJM.org.

New England Journal of Medicine 384(25):p 2428-2436, June 24, 2021. | DOI: 10.1056/NEJMcp1914037

Key Clinical Points

STRESS INCONTINENCE in WOMEN

Stress incontinence is common among women, yet less than 40% of affected women seek care.
Screening can be easily achieved by asking women if they have urinary leakage with coughing, laughing, sneezing, or exercise.
Exercises that strengthen the pelvic-floor muscles are effective in controlling stress incontinence, and weight loss is recommended in overweight or obese women.
Referral to a specialist for an incontinence pessary or surgery should be considered if behavioral therapy options have failed and the patient continues to have bothersome symptoms.
Surgery is the most effective option; shared decision making should entail a detailed discussion of the risks and benefits of different surgical procedures.
The most commonly performed surgery is placement of a midurethral mesh sling, a minimally invasive, outpatient, 30-minute procedure with high efficacy and a relatively low rate of complications.