- Clinical science
Urinary incontinence is a common condition characterized by uncontrollable leakage of urine. Causes and presentation are variable. Stress incontinence, urge incontinence, and mixed incontinence are the most frequent forms. Urinary incontinence remains a grossly underreported condition in the US, affecting approximately 30–40% of the adults older than 65 years of age. The condition is twice as common in women as men. Diagnosis involves a detailed medical history, a voiding diary, physical examination, and diagnostic testing such as measurement of the bladder pressure (urodynamic examination). Treatment is determined based on the type of incontinence and its etiology, and usually involves measures such as pelvic floor physiotherapy, anti-incontinence devices, anticholinergics, or collecting devices. The prognosis in adequately treated cases is usually excellent, but, if left untreated, constant contact with leaked urine can cause urinary tract infections, dermatitis, and psychological distress.
- General risk factors
- Neurological causes
- Genitourinary causes
- Potentially reversible causes
DIAPPERS: Delirium/confusion, Infection, Atrophic urethritis/vaginitis, Pharmaceutical, Psychiatric causes (especially depression), Excessive urinary output (hyperglycemia, hypercalcemia, CHF), Restricted mobility, Stool impaction.
|Type of incontinence||Pathophysiological mechanism||Key features||Treatment|
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|Mixed incontinence|| || |
|Total incontinence|| || || |
|Overflow incontinence (overflow bladder)|| |
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|Further causes of urinary incontinence|| |
Neural control of micturition: parasympathetic nervous system → S2–S4 ventral root → inferior hypogastric plexus → contraction of the detrusor muscle → voluntary relaxation of the external urethral sphincter muscle via the pudendal nerve → micturition!
Basic diagnostic testing
- Detailed medical history (including medication)
- Voiding diary to assess frequency and volume of micturition
- Neurological, vaginal, and rectal examination
- Laboratory tests
- Quantification of residual urine after micturition
- Renal ultrasound
- Quantification of leaked urine:
Additional diagnostic testing
- Micturating cysto-urethrogram (MCU) to detect morphological abnormalities
- Urodynamic examination to measure bladder pressure and urethral closure pressure
- Cystoscopy to rule out tumors and vesicorectal or vesicovaginal fistulae
- MRI to identify pelvic floor defects
- See also “Diagnostics” in and .
- Modify contributing factors (e.g., drugs) and treat reversible causes.
Physical measures to prevent leakage
- Absorbent products
- Urethral occlusion
- Pessaries and penile compression devices
- Weight loss
- Dietary changes (e.g., decrease consumption of alcohol, caffeine, carbonated drinks)
- Smoking cessation
- Behavioral therapies and exercises
- Management of constipation
- Topical vaginal estrogen in postmenopausal patients with vaginal atrophy
Other treatment options depend on the form of urinary incontinence; see “Overview” section above as well as and .