Abstract: Stress urinary incontinence is a common disease in adult women, and with the aging of the population and the increasing demand for quality of life, the problem of stress urinary incontinence in women is receiving increasing attention. In an epidemiological survey of adult female urinary incontinence, stress incontinence accounts for more than half of urinary incontinence, and the prevalence rate of postmenopausal population is even as high as 50%, which seriously affects the health and quality of life of women. China is now tending to age, as a common disease in middle-aged and elderly women, the study of stress urinary incontinence onset and risk factors has become an important topic. According to the International Continence Society (ICS), urinary incontinence (UI) is the loss of urinary self-control due to bladder sphincter injury or neurological dysfunction, resulting in the involuntary flow of urine. Stress urinary incontinence (SUI), also known as tension incontinence, is a disorder in which urine flows out involuntarily due to flaccidity and weakness of the urethral sphincter when the intra-abdominal pressure is increased, when standing upright, or when walking. Stress urinary incontinence can be based on the history and symptoms to make a preliminary diagnosis, gynecologic systemic physical examination and correct analysis of the examination results to the clinical diagnosis and treatment of stress urinary incontinence provides more favorable evidence. The diagnosis of stress urinary incontinence is based on history and symptoms (delivery history, complaints); physical examination (measurement of residual urine and urinary routine examination, tension test, pad test, finger pressure test, swab test, identification of damage to pelvic floor tissue); and ancillary examinations (ultrasound, X-ray, urethral pressure test, urodynamic measurements). Stress incontinence is divided into 4 degrees according to Gullen’s criteria: degree I: occasional incontinence when coughing and other sudden increases in abdominal pressure; degree II: incontinence every time coughing and breath holding or exertion; degree III: incontinence immediately with walking and standing; degree IV: incontinence even in bed [1]. Urge urinary incontinence (UUI) is the flow of urine through the urethra when there is a strong urge to urinate that cannot be controlled by the will. Urge incontinence is only a severe manifestation of overactive bladder disorder. Common causes of urge incontinence include aging of the detrusor muscle, cardiovascular disease, early diabetes mellitus, and urinary tract infection. Urge incontinence is diagnosed mainly by measuring the urinary flow rate and residual urine volume and, if necessary, by performing urodynamic tests to determine the presence of obstruction. This type of incontinence is characterized by a strong urge to urinate followed by urinary incontinence or occurs when a strong urge to urinate is present. Its occurrence can be triggered by coughing, sneezing or increasing abdominal pressure and can be easily confused with stress incontinence. Depending on the cause, urge incontinence can be divided into motor urge incontinence and sensory urge incontinence. Mixed urinary incontinence (MUI) refers to the involuntary flow of urine when there is a sudden increase in abdominal pressure and urinary urgency. That is, when coughing, running, weight-bearing and other increases in abdominal pressure will have involuntary urine outflow, and accompanied by urinary frequency, urinary urgency and urinary leakage due to untimely urination. 2, female stress urinary incontinence epidemiological survey: At present, the epidemiological survey of adult female stress urinary incontinence is mainly descriptive, and a large number of large-scale epidemiological surveys of adult female stress urinary incontinence have been conducted worldwide. However, the findings on the prevalence of stress urinary incontinence in adult women vary greatly due to the cultural background of the respondents and the methods of investigation. The survey found that 35% (44%, 41%, 42% and 23% in France, Germany, Spain and the UK, respectively) of women had symptoms of urinary incontinence, with stress incontinence predominating [2]. Regional epidemiological surveys on the prevalence of stress urinary incontinence in adult women have been conducted in recent years in various parts of China. In a survey of 5221 adult women (aged 20 years or older) in Beijing in 2005, the prevalence of UI was 38.5%, SUI was 22.9%, UUI was 2.8%, and MUI was 12.4% [3]. A survey on the prevalence of stress urinary incontinence was conducted on 1465 women over 40 years of age in three communities in Shanghai, and the results showed that the prevalence of urinary incontinence was 37.3%, including 21% for stress urinary incontinence, 6% for urge urinary incontinence, and 9.8% for mixed urinary incontinence, of which the consultation rate was only 6.2% [4], and there has not been a comprehensive and systematic national survey. 3, factors in the development of stress urinary incontinence: So far, a large number of epidemiological studies have reported on the factors in the development of stress urinary incontinence, most of which concluded that age, obesity, pregnancy and childbirth, menopause and estrogen levels, pelvic surgery, chronic pelvic pain and pelvic organ prolapse, and dietary lifestyle are high-risk factors affecting the development of stress urinary incontinence. 3.1 Age factor: Almost all epidemiological investigations have concluded that the age factor is closely associated with the development of stress urinary incontinence, and K1auser et al. found that the thickness and function of the urethral sphincter decreased significantly with increasing age in patients with stress urinary incontinence, which may be related to the increase in the prevalence of stress urinary incontinence with age [5]. However, there is still disagreement among them: the Norwegian EPINCONT study of a large sample of 27936 community-dwelling adult women of all ages found that stress urinary incontinence was more common in young and middle-aged adults, accounting for approximately 50% of cases, with a peak incidence of SUI between 45-55 years of age, more moderate between 55 and 70 years of age, and a slight increase after 70 years of age [6]; while Minassian et al. concluded that stress urinary incontinence There is a peak incidence of stress urinary incontinence, and as the incidence of mixed incontinence increases, there is a slow decline in the incidence of stress urinary incontinence, and 80 years of age is proposed as the lowest point of incidence[7]. 3.2 Body mass index (BMI) factors: The vast majority of surveys have shown that body mass index is strongly associated with the prevalence of stress urinary incontinence in women, with obese people being at high risk of the disease. The mechanism of stress urinary incontinence in obese people is not well understood. Bump et al. found that the prevalence of stress incontinence decreased from 61% before surgery to 12% after 1 year of surgical weight loss in patients with stress incontinence [8]. The results of the survey in Beijing showed that the prevalence of stress urinary incontinence was 1.3 times higher in people with 2428 than in people with BMI<24.3 Abdominal obesity is more likely to cause stress urinary incontinence, and the waist circumference and waist-hip ratio can better reflect the difference in body shape of obese people, and waist circumference is the basic condition for the diagnosis of metabolic syndrome (waist circumference > 88 cm is abdominal obesity). 88 cm is abdominal obesity), metabolic syndrome-induced metabolic abnormalities and hypertension may be related to the onset of stress urinary incontinence [9]. 3.3 Pregnancy and childbirth factors: The effects of pregnancy and childbirth on the pelvic floor neuromuscles, the action of hormones during pregnancy and the mode of delivery may be associated with the development of stress urinary incontinence in women. Several surveys have investigated factors such as neonatal weight, mode of delivery, number of deliveries, presence or absence of forceps assisted delivery, and lateralization of the perineum, and the majority of the results concluded that vaginal delivery, increased number of deliveries, and prolonged labor increased the risk of stress urinary incontinence.3 4 In Guangzhou, a survey of 338 people found that the incidence of urinary incontinence in women with different modes of delivery was, in descending order, forceps assisted delivery and attraction delivery, normal delivery, and cesarean delivery. This suggests that the damage to the pelvic floor tissues during delivery may be a cause of urinary incontinence [10]. While there are two opinions on whether lateral episiotomy can improve the risk of developing stress urinary incontinence, a survey of 278 women by Viktrup et al. in 2001 found an increased incidence of stress urinary incontinence 5 years postpartum in women with episiotomy [11]; findings in Beijing and Shanghai, China, suggest that lateral episiotomy can effectively improve the incidence of stress urinary incontinence in women3 4; similarly, there are reports indicating that lateral perineal incision and median line incision commonly used during delivery do not reduce the damage to the pelvic floor tissues and decrease the incidence of postpartum stress urinary incontinence and pelvic organ prolapse during delivery [12]. 3.4 Menopause and estrogen levels There is also a correlation between estrogen levels on stress urinary incontinence in women. A survey of stress urinary incontinence in adult women in Beijing concluded that the risk of stress urinary incontinence was l.5 times higher in those aged <50 years in the menopausal population (surgical or natural menopause) than in the non-menopausal population.3 Some studies have reported that there are a large number of estrogen receptors in the tissues of the main ligament, uterosacral ligament, anal levator muscle and posterior vaginal fornix, and that estrogen receptor expression in vaginal wall tissue is positively correlated with blood estradiol levels in postmenopausal The significant absence of estrogen receptor expression in the vaginal wall of postmenopausal women may be an important factor in the increased incidence of postmenopausal stress urinary incontinence [13]. However, studies on the application of estrogen for the treatment of stress urinary incontinence are controversial. Although estrogen supplementation can improve the blood supply to the bladder and urethra and increase the thickness and resistance of the urethral mucosa, it cannot fundamentally change the weakness of the supporting structures of the pelvic floor [14]. 3.5 Gynecological surgery (cesarean section, sterilization, appendectomy, ectopic pregnancy, gynecological tumors, intestinal tumors, total hysterectomy) By performing gynecological pelvic examinations in 515 women aged 45 years, Hording et al. found a 30% prevalence of urinary incontinence after transabdominal total hysterectomy [15]. Possible mechanisms for urinary incontinence after hysterectomy are (i) hormonal mechanisms (for women, hysterectomy plus oophorectomy is surgical menopause), (ii) damage to the pelvic floor nerves during surgery, and (iii) damage to the myofascial tissue connecting the bladder to the surrounding pelvic wall [16].In a survey of 3896 women, Milsom et al. found a higher prevalence of urinary incontinence in those with hysterectomy than in those without hysterectomy. The prevalence was 21% and 16% in both cases. It has also been suggested that hysterectomy is not associated with urinary incontinence, especially stress urinary incontinence [17]. 3.6 Chronic Pelvic Pain CPP and Pelvic organ prolapse POP In an epidemiological survey of stress urinary incontinence in adult women in Beijing, the prevalence of stress urinary incontinence was found to be significantly higher in those with CPP than in those without CPP; one-way logistic regression indicated that CPP was Single-factor logistic regression showed that CPP was a risk factor for stress urinary incontinence, and multi-factor regression suggested that CPP was an independent risk factor for stress urinary incontinence, and the risk of SUI was 1.4 times higher in people with CPP than in those without CPP.3 Clinically, stress urinary incontinence and POP are highly correlated, with 80% of patients with stress urinary incontinence having POP and 50% of patients with POP having stress urinary incontinence. Tissue smooth muscle fiber thinning, disorganized alignment, connective tissue fibrosis and muscle fiber atrophy may be associated with the development of stress urinary incontinence [18]. 3.7 Dietary factors Dallosso et al. suggested that increased fat intake and high consumption of carbonated beverages are associated with an increased risk of stress urinary incontinence, while the trace elements zinc and vitamin B12 are positively associated with the development of stress urinary incontinence, possibly because excessive plasma Zn concentrations can alter the structure of plasma lipoproteins, impair the muscular immune system and indirectly increase the risk of SUI [19] [20]. Carbohydrates reduce the risk of stress urinary incontinence. It has also been suggested that coffee and smoking are risk factors for stress urinary incontinence. 3.8 Other factors A survey on the quality of sexual life of 3372 women with urinary incontinence in Korea found a significant correlation between the scores of sexual life and urinary incontinence. This survey has become a popular topic with the increasing attention to quality of life, especially sexual quality of life, but no studies have found a clear reason to confirm this finding. Other findings suggest that race, occupation, family history, childhood enuresis, urinary tract infection, constipation, fecal incontinence, impaired detrusor function, nocturia, chronic obstructive pulmonary disease, diabetes mellitus, congestive heart failure, exercise, radiation therapy, diuretic use, Parkinson's disease, dementia, stroke, and depression may be risk factors for stress urinary incontinence [21] [22] [23]. 4, Conclusion Stress urinary incontinence not only makes the patient's body odorous, but also causes embarrassment and frustration, limits social activities, also limits physical activities and physical labor, and requires daily use of sanitary pads and even urine pants in severe cases, which seriously affects the quality of life. Statistics from the United States in 1993 cost approximately $164 million per year for people with urinary incontinence, even more than the combined cost of coronary artery bypass and kidney transplantation [24]. There is currently a poor awareness of urinary incontinence and low consultation rates globally, with little attention paid to urinary incontinence in our country. A nationwide epidemiological survey of stress urinary incontinence in adult women should be conducted at this time to vigorously promote knowledge of stress urinary incontinence and to raise awareness and provide guidance and assistance to women throughout society. Based on the principle of early detection, early medical consultation and early treatment, the current situation in China should be improved so that more female patients can get rid of the inconvenience and pain caused by stress urinary incontinence.