To Laugh is to P-- but should it be?

To Laugh is to pee but it should it be?

B: Stress Urinary Leakage or Incontinence or SUI- is associated with an increase in abdominal pressure; this leakage does not occur at rest To and is not associated with a sense of urgency to urinate. Severity varies depending on the underlying cause.  Women with mild stress incontinence report low volume leakage with marked increase in abdominal pressure commonly triggered by coughing, laughing, running, sneezing, jumping, or lifting.  Some women may experience significant leakage with mild increase in abdominal pressure such as rising from a sitting position. In these cases there may be very weak sphincter muscles as well.  Symptoms may worsen with weight gain, heavy lifting, constipation or atrophy from frequent coughing or straining.

M:The patient believes that SUI is more prevalent in the community than is reported due to modesty and privacy.  The patient experienced SUI and following some heavy lifting and persistent cough for 2 weeks began to experience more severe SUI symptoms leading to decreased libido, anxiety and depression, affecting her quality of life 30-40%. The 41 yo consulted a urologist and was scheduled for an anterior vaginal suspension procedure to treat her SUI.  Upon discussing the upcoming surgery with her OBGYN the decision was made to post-pone surgery and try nonsurgical management using a pessary. The pt was diagnosed with a grade 2 cystocele due to pelvic descenus of bladder and slight rectocele, as well as levator ani muscle spasm with pain on exam. Rehabilitation with a Pelvic Floor Physical Therapy was prescribed.  

C: Subject's symptoms improved going from daily usage of incontinence pad to using no incontinence under pad.  Pt's quality of life improved and she feels that she is in control of her bladder rather than her bladder controlling her.