Question

A patient with 2nd degree cervical prolapse complains of dribbling of urine on cough. What is the diagnosis?

• A. Stress incontinence
• B. Overflow incontinence
• C. Cystitis
• D. Functional incontinence

Hint:

Think about what happens to the bladder neck when pelvic floor support is lost and intra-abdominal pressure suddenly rises.

Answer 1

The Correct Option is A

Approach: The key is the trigger -- urine leaks specifically on coughing (raised intra-abdominal pressure).

Types of incontinence:

• Stress incontinence: leakage on effort/cough/sneeze due to deficient urethral closure mechanism.
• Overflow incontinence: continuous dribble from overdistended bladder.
• Urge incontinence: sudden urge followed by involuntary leakage (detrusor overactivity).
• Functional incontinence: normal bladder but inability to reach toilet.

Mechanism in prolapse: 2nd degree uterine prolapse causes descent of the bladder base (cystocele), posteriorising the urethrovesical junction and reducing the posterior urethrovesical angle. This impairs the pressure transmission ratio between urethra and bladder, so coughing produces net positive intravesical pressure exceeding urethral closure pressure -- resulting in leakage.

\[\boxed{\text{Stress incontinence}}\]