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

Step 1: Identify the clinical clue. The patient has 2nd degree cervical (uterine) prolapse and leaks urine specifically on coughing. The trigger is a sudden rise in intra-abdominal pressure.

Step 2: Define the options.

• Stress incontinence: Involuntary urine leakage triggered by coughing, sneezing, or physical effort due to weakened pelvic floor and urethral sphincter unable to resist the pressure surge.
• Overflow incontinence: Continuous dribbling from an overfull bladder due to detrusor underactivity or outflow obstruction -- not effort-related.
• Cystitis: Bladder inflammation causing dysuria, frequency, urgency -- not activity-triggered leakage.
• Functional incontinence: Leakage due to inability to reach the toilet from physical or cognitive impairment, not a sphincter defect.

Step 3: Apply to pelvic prolapse. In uterovaginal prolapse, the bladder descends (cystocele), distorting the urethrovesical angle and weakening pelvic floor support. Any sudden increase in intra-abdominal pressure (e.g., coughing) is transmitted to the bladder but not adequately resisted at the bladder neck, resulting in stress incontinence.

Conclusion: Urine leakage on coughing in a patient with uterine prolapse is classic stress incontinence.