Stress incontinence is the most common form of urine loss. It usually affects women after childbirth or menopause. It is characterized by slight leakage of urine when sneezing, laughing, and coughing or during exercise or sexual activity. Anything that puts pressure on the abdomen can also increase the pressure on the pelvic floor muscles that need to be tightened to ensure the closure of the uro-genital tract. If these muscles are weak, they won’t be able to maintain the tension. If the tension is less, then the urethra opens and small drops of urine may be released.

Depending on the intensity of the stress that determines it, urinary incontinence can be broken down into three categories of increasing severity:

1. Stage I: coughing, sneezing, laughing;
2. Stage II: lifting heavy objects, change in position, brisk walking, walking down stairs, jumping;
3. Stage III: the smallest effort.

Continence is certain when a gradient-urethral bladder is maintained called closing pressure (PC = PUrethra - PVescica (Bladder)) if this is positive, that is to say PU> PV.
The escape or leakage of urine occurs when the forces of expulsion resulting from abdominal pressure or detrusor contraction exceed the retention forces of the urethra. In this case the urethral-bladder gradient is inverted (PV> PU) and continence is no longer guaranteed.

This disorder affects women, especially the elderly, over 60, but can also occur at any age. In fact, a significant 20% of cases involving women under age 30 and nearly 40% are women between the ages of 30 and 50 years old.
Among the factors that facilitate the onset of this disorder, there are:

• chronic constipation, a problem that affects mostly women,
• low levels of physical activity that contribute to the increase in body weight; that is one of the conditions favouring the onset of this disorder, even among those young women who abruptly cease physical activity or sports can manifest this problem
• recurrent infections of the urinary tract,
• endogenous depression,
• menopause where the drop in estrogen, which are partly responsible for muscle tone, helps lowering the muscle tone also in the pelvis,
• some medications, particularly antidepressants, antipsychotics, anticholinergics, diuretics, analgesics, central narcotics, sedatives etc.,
• some food substances and foods such as apples, coffee, grapes, pineapple, strawberries, lemon, sugar, vinegar, tomato, tea, coffee and carbonated soft drinks.

Factors that increase urinary incontinence are:

• Natural childbirth is a factor that causes a woman to suffer from this disorder, because the pelvic region is much stressed. Think about the perineum zone that is often scarred by episiotomy (surgical incisions during delivery),
• surgery in the pelvic zone.

 
In addition to these factors there are others more related to the predisposition of the individual:

• heredity, the daughters of mothers who are incontinent have 3 times a greater risk of suffering from the disorder,
• neurological diseases, e.g., 85% of women suffering from Parkinson's suffers as 50 to 80% of those with multiple sclerosis
• genital prolapse..

It would be good for patients suffering from incontinence to observe some good rules regarding diet and bad habits:

• Spicy foods should be avoided
• Even avoid smoking, alcoholic beverages and coffee
• Avoid drinking water before bedtime
• Keep your weight under control
• Proper bowel function is lso of great help
• Avoid all the excessive physical activity that could possibly worsen your condition

The aspect of rehabilitation is very important as its goal is to give the person the possibility to control urine retention. It’s a process that must be personalized and is used to retrain the muscles of the perineum, the area that is located between the anus and the vagina, using some exercises that are already being offered in certain pre-partum courses and are also recommended during the postpartum period. 60 to 70% of patients experience an improvement and, in the case of light incontinence, it almost always provides a complete solution to the problem. In severe cases, using rehabilitative therapy, you can usually avoid the need for surgery. In particular, physiokinesis therapy uses both active and passive exercises that work on the muscles of the pelvic floor. The exercises should be performed by trying to coordinate both posture and breathing. The goal is to tone muscles, improve the reflection of the perineal closure following stress, and to improve the sensitivity in the perineum in general. These exercises can and should be performed daily by the patient, even when alone. It usually takes at least 2 months before you see some results, and it is still essential to be committed and determined if f the patient should perform these exercises recommended.
Conservative treatment (rehabilitation) of urinary incontinence should be considered as a treatment of first choice, for its effectiveness, low-cost and the absence of risk. And if after 2 to 3 months of treatment, there are no improvements, the patient should be informed of other therapies.

Bladder training (bladder gymnastics) is an educational process consisting of exercises similar to those already used in physiokinesis therapy. However, they are also accompanied by patient diary, in which the patient records micturition patterns and teaches herself how to regulate the ingestion of liquids with the goal of reducing the total number of urinations. The diary is an important element because it serves to actively involve the patient and is a great tool of the progress of the therapy, which usually takes about 2 or 3 months to show improvement. The bladder training is used in cases of mixed incontinence and overactive bladder syndrome.

Recent studies have investigated the possibility of applying the source of energy, supplied by the laser source, to improve mild urinary incontinence. Certain points of heat are applied and a special vaginal handpiece, which, taking advantage of the fibroblastic regeneration of thesubmucosal tissue, foster an improvement of urinary continence.
This method, although in its first stages, seems to have a huge potential for development.

Surgery has always been considered the gold standard in the treatment of female stress urinary incontinence, even more so after the advent of minimally invasive techniques. This means a less bloody approach without compromising the natural healing properties, resulting in a lower risk of post-surgical complications, and therefore a reduced hospital stay with a subsequent early return to daily activities.
The purpose of this procedure is to restore the support for the bladder and the urethra.
Among those techniques is the TVT. In all its variants, the TVT technique consists of positioning a small dressing of synthetic material that serves as a support for the urethra. The original technique involves the introduction, affecting the vagina, of a small dressing by using two needles that, with a guided path, pass behind the pubic bone (the front of the pelvis) and protrude slightly above the pubis.
The small dressing The bendarella is then cut to the level of the skin and small incisions are closed with a suture or with a piece of adhesive skin.
Over ten years of history confirm the absolute validity of this technique. The technique, known as TOT (transobturator-tape), provides for the passage of two helical needles laterally behind the pubic bone, but not like the first generation technique. Precisely these needles, known by the term tunneler, pass through the obturator foramina (2 sided openings in the pelvis). This passage lent its name to the technique (transobturator-tape). In fact, the use of this technique performs the procedure more quickly and with fewer complications. The variation of the technique involves the use of very small needles and avoids the need to damage the skin, thanks to the use of special technology, which maintains the small dressing in position.
This variant of the technique seems to guarantee less invasiveness and the almost total absence of pain, which doesn’t exceed the obturator membrane. The treatment using bulking substances (bulking agents) was created out of the need to narrow the urethral lumen without causing a significant obstruction.
Selected candidates are patients with major losses, because of age or general conditions, are at risk of requiring surgical intervention.
Limit of the procedure is decided by the necessary time required for the treatment. However, since the technique is simple and easy to do, it can be repeated several times.