I. Definition Stress incontinence: A sudden increase in abdominal pressure leads to involuntary outflow of urine. It is characterized by involuntary leakage of urine from the urethra when coughing, laughing, sneezing, jumping or lifting heavy objects. If this phenomenon occurs occasionally, it can not be regarded as a pathological state, and it is only a pathological phenomenon when urinary incontinence affects life frequently. Second, the main causes 1, pregnancy and vaginal delivery as the main cause of stress incontinence. During pregnancy and delivery, excessive pressure on pelvic floor muscles by fetal prenatal exposure, vaginal surgery such as fetal head attractor and breech traction, and increased post-partum abdominal pressure can cause pelvic floor tissue relaxation. 2.Urethral and vaginal surgery Vaginal anterior and posterior wall repair, radical cervical cancer surgery, urethral diverticulectomy, etc. can destroy the normal anatomical support of the urinary bladder. 3.Age The cause of the disease in young women and women who have not given birth is congenital insufficient support of the tissues around the bladder and urethra or unsound innervation; pre-menopausal onset of the disease is often due to malnutrition, weakness, resulting in incontinence due to atrophy of the muscles of the neck of the urethral bladder and the fascia; postmenopausal women due to the decrease in oestrogen, the urethra and the surrounding pelvic floor muscle atrophy and urinary incontinence. 4, pelvic mass when there is a huge pelvic mass, such as uterine fibroids, ovarian cysts, resulting in increased abdominal pressure, the bladder and urethra junction position is reduced and urinary incontinence. 5, cyclic stress incontinence in the second half of menstruation stress incontinence symptoms are more pronounced, may be related to progesterone relaxation of the urethra. 6, race and genetic factors with a family history of urinary incontinence and pelvic organ prolapse family history of female stress urinary incontinence is likely to be greater, it is also believed that the prevalence of urinary incontinence in white women than black. 7, other possible factors Hypertension, obesity, lung disease, etc. are also related factors leading to female stress urinary incontinence. The purpose of stress incontinence diagnosis is to confirm that incontinence is caused by increased abdominal pressure. 1, ask the medical history to understand and stress urinary incontinence related to a variety of reasons (such as childbirth, trauma, pelvic surgery, etc.); urinary incontinence on the patient’s life; there is no difficulty in urination symptoms, and there is no forced urinary muscle overactivity. 2.Symptoms Urine leaks out of the urethra involuntarily when coughing, laughing, sneezing, or lifting heavy objects. Clinically, it can be divided into three degrees: degree I: incontinence occurs when coughing, sneezing, lifting heavy objects and other abdominal pressure increases; degree II: incontinence occurs when standing or walking; degree III: incontinence occurs in either upright or lying position. Fourth, the relevant examination 1, physical examination ① measurement of urethra length: insert the balloon catheter, balloon filled with 20ml of water, gently pull to the inner mouth of the urethra, calculate the length of the urethra. The normal length of female urethra is about 4cm, if the length of urethra is shortened in standing position or shortened in standing and lying position, there is a possibility of stress urinary incontinence. ② bladder neck lifting test: the patient to take the lithotomy position, in the bladder is full, increase the abdominal pressure, urine outflow; at this time, the index finger and middle finger inserted into the vagina, in the bladder neck on both sides of the urethra will be lifted upward, such as aborted urinary flow is positive. (iii) Swab test: used to determine the degree of urethral prolapse. Take the bladder in the lithotomy position, insert a swab into the urethra after routine sterilization. Normal people in the stress and stress-free state of the swab activity angle should not be > 30 °, if > 30 ° indicates that the bladder, urethra supportive tissues are weak. 2, other auxiliary examination: 1, urodynamic examination The urethral muscle reflex is normal, the maximum urinary flow rate increases significantly in stress urinary incontinence, the intravesical pressure during voiding period decreases significantly, the intravesical pressure in mild cases is 5,9-7,8kPa, in moderate cases it is 2,5-5,9kPa, and in severe cases it is lower than 1,96kPa. urethral pressure decreases, the maximum urethral pressure decreases significantly, and when it is shifted from the prone position to the upright position, its urethral Leakage point pressure (LPP) is measured by placing a manometric tube into the bladder and filling the bladder to record the pressure in the bladder when urethral leakage occurs, which is the leakage point pressure. This pressure is the leakage point pressure. Most of the mild cases are higher than 11,8kPa, and most of the severe cases are lower than 5,88kPa.3. Maximum functional bladder capacity and residual urine measurement are normal.4. Urethrocystography Normal bladder posterior angle should be 90°-100°, the vertical line between upper urethral axis and the vertical line of the standing position, forming an angle of inclination of the urethra of about 30 °, the neck of the bladder is higher than the lower edge of the symphysis pubis. In stress incontinence, the bladder urethral angle disappears, the bladder neck is lower than the lower edge of the pubic symphysis, the urethral angle of inclination increases, the bladder neck is funnel-shaped and prolapsed, and the urethral axis undergoes different degrees of downward and backward rotation. Conservative treatment (1) Pelvic floor muscle training: through the correct method of contraction of the anal sphincter, vaginal sphincter and urethral sphincter, to strengthen the pelvic floor muscle tone, reduce the degree of urethral bladder downward movement. Methods: contract the anus 10-20 times every half hour, each lasting more than 3s. (2) Acupuncture or electrical stimulation therapy: acupuncture Guanyuan, Qihai, Sanyinjiao, and Ashigangsanli and other acupoints, selecting 1 to 2 acupoints each time, or electrical stimulation of the pelvic floor muscles through anal electrodes or vaginal electrodes to achieve the therapeutic purpose. (3) Pharmacological treatment: 1. Chinese medicine: advance herbal intervention to regulate the spleen and kidney and prevent urinary incontinence, such as tonifying the middle and benefiting the qi soup by adding subtractions. 2. Western medicines: such as drugs to inhibit the contraction of the forced urethra muscle, drugs to increase urethral resistance; estrogen. (4) Transurethral submucosal injection treatment: Teflon Teflon cream, collagen, bio-gel or autologous adipose tissue is injected into the submucosal and muscular layer of the posterior urethra or bladder neck to make the urethral lumen narrow and elongate, and play the role of closing the urethral incontinence. This method is suitable for the stress incontinence caused by the dysfunction of the internal urethral sphincter. Sixth, surgical therapy When serious urinary incontinence occurs, you can choose the appropriate surgical treatment. Such as anterior vaginal wall repair; retropubic bladder neck urethral suspension; bladder neck or urethral sling surgery; endoscopic bladder neck suspension. Diet and health care Stress urinary incontinence dietary remedies: 1) ten red dates, boiled in water, once a day. 2) five red dates, 50 grams of Gorgon fruit, porridge. 3) 10 grams of schizandra, 10 grams of black sesame, 10 grams of ripe earth, brown sugar, plus 500 milliliters of water decoction, etc.. VIII. Prognosis and protection With the aging of the population and the improvement of medical care, people’s demand for quality of life has increased accordingly. Stress urinary incontinence is a curable disease. The important thing is early detection, active protection and treatment. It is important to avoid multiple pregnancies and births, avoid medical injuries, avoid vaginal injuries, and develop good lifestyle habits, including weight control, reducing caffeine intake, quitting smoking, controlling respiratory diseases, treating constipation, and balancing fluid intake to avoid excessive fluid intake that leads to urinary frequency and urgency, and so on.