Anatomy of occult stress urinary incontinence

(A) Advanced anterior or apical pelvic organ prolapse (usually prolapse past the vaginal introitus) displaces the bladder neck posteriorly, and the urethra is kinked, resulting in urethral obstruction. The obstruction then becomes the mechanism of continence.
(B) When the prolapsed structures are elevated (approximating normal anatomy) during prolapse reduction testing in women with urethral obstruction due to advanced prolapse, the urethra is unblocked, and stress urinary incontinence often becomes evident when a urinary stress test is performed.