- Clinical science
Urinary incontinence is a common condition characterized by uncontrollable leakage of urine. Causes and presentations 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.
- Increases with age
- Up to 50% of women and up to 25% of men older than 65 years are affected.
- Sex: ♀ > ♂ (2:1) 
Epidemiological data refers to the US, unless otherwise specified.
- Neurological causes
- Genitourinary causes
- Potentially reversible causes
- General risk factors
DIAPPERS: Delirium/confusion, Infection, Atrophic urethritis/vaginitis, Pharmaceutical, Psychiatric causes (especially depression), Excessive urinary output (hyperglycemia, hypercalcemia, CHF), Restricted mobility, Stool impaction.
|Overview of urinary incontinence|
|Type of incontinence||Pathophysiological mechanism||Key features ||Treatment |
|Stress incontinence|| || |
|Urge incontinence || |
|Mixed incontinence|| |
|Total incontinence|| || |
|Overflow incontinence (overflow bladder)|| |
|Further causes of urinary incontinence|| |
|Enuresis risoria || || || |
Basic diagnostic testing
- Detailed medical history (including medication)
- Voiding diary: to assess the frequency and volume of micturition
- Neurological, vaginal, and rectal examination: to detect local sites of infection (e.g., abscesses, sebaceous cysts), anomalies of local anatomy, neurological deficits, and rectal sphincter flaccidity
- Laboratory tests
- Quantification of leaked urine:
Additional diagnostic testing
- Micturating cystourethrogram (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 “” articles for more information.
- Weight loss
- Dietary changes (e.g., decrease consumption of alcohol, caffeine, carbonated drinks)
- Smoking cessation
- Modification of other contributing factors (e.g., drugs)
- Behavioral therapies and exercises
- Physical measures to prevent leakage
- Management of reversible causes (e.g., constipation)
- Topical vaginal estrogen (in postmenopausal patients with vaginal atrophy)
|Autonomic drugs used to treat bladder incontinence|
|Drug group||Example drugs||Mechanism of action||Indication|
Other treatment options depend on the form of urinary incontinence; see the “Overview” section above as well as “” and “ ” articles.