What is the defining symptom of stress urinary incontinence?

• A. Leakage with increased intra-abdominal pressure (e.g., coughing, sneezing, laughing) without a preceding detrusor contraction.
• B. Leakage only after a detrusor contraction.
• C. Urgent sensation to empty the bladder.
• D. No leakage regardless of activity.

Answer: (A)

Leakage that occurs with activities that increase intra-abdominal pressure (such as coughing, sneezing, laughing, or lifting) in the absence of a preceding detrusor contraction. This pattern is the hallmark of stress urinary incontinence, reflecting insufficient urethral support or sphincter function so the urethra can’t stay closed under sudden pressure, even though the bladder isn’t actively contracting.

In contrast, urge incontinence involves leakage that is associated with a sudden, strong urge to void and detrusor overactivity, not with a pressure-related leak alone. No leakage during all activities would indicate continence. Leakage only after a detrusor contraction aligns more with leakage driven by bladder contraction rather than stress incontinence.