Urinary continence in women is intimately associated with adequate support of the neck of the bladder. Any increase in tone of the bladder musculature, or in the intravesicular pressure, substantially increases the liability to incontinence. Obstetrical trauma may cause stress incontinence by disrupting supports of the neck of the bladder and by stretching the fascial structures of the posterior portion of the neck of the bladder. Minor injury not grossly demonstrable may occur in this way and upset the very delicate balance existing between the forces of the detrusor muscle and the resistance of the urethrovesical junction.In correcting the defects associated with stress incontinence, there are specific indications for various methods—active exercise, plastic reconstruction of the bladder and urethral supports, and the various operations for suspension of the neck of the bladder.
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