Illness script
Stress Urinary Incontinence
Leakage of urine with coughing, sneezing, laughing, or exertion, typically in a multiparous or postmenopausal woman.
This illness script for Stress Urinary Incontinence covers the classic presentation, who it affects, how you work it up, the mechanism, and first-line treatment—written for USMLE Step 1 and clerkship clinical reasoning.
Updated Jul 18, 2026All scripts
01
Who it affects
- Women, especially multiparous and postmenopausal
- Risk: vaginal delivery, obesity, chronic cough, aging
- Prior pelvic surgery or prolapse
- Men after prostatectomy (sphincter damage)
- Smoking and high-impact activities
02
Diagnostics & workup
- History: leakage with cough/sneeze/laugh/lifting, no urge
- Cough stress test: visible leak with cough
- Positive Q-tip test (urethral hypermobility >30°)
- Post-void residual to exclude overflow
- Urinalysis to rule out infection
- Urodynamics if diagnosis unclear or before surgery
03
Pathophysiology
- Urethral hypermobility from weakened pelvic floor support
- Loss of pelvic floor muscle/ligament tone
- Intrinsic sphincter deficiency in some cases
- Increased abdominal pressure overcomes urethral closure
- Estrogen loss reduces urethral tissue integrity
04
Treatment
- First-line: pelvic floor (Kegel) exercises
- Weight loss, smoking cessation, reduce caffeine
- Pessary or vaginal support device
- Topical vaginal estrogen in postmenopausal women
- Midurethral sling surgery for refractory cases
- Duloxetine (limited use); no strong pharmacologic first-line
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Educational use only. This illness script is a study framework, not medical advice. Confirm decisions with current guidelines and your clinical supervisors.