• Clinical science

Urinary incontinence


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.



Epidemiological data refers to the US, unless otherwise specified.


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
Stress incontinence
  • Urinary leakage on activities that increase intra-abdominal pressure
Urge incontinence
  • Inflammatory conditions or neurogenic disorders → sphincter dysfunction, detrusor overactivity or overactive bladder autonomous contractions of the detrusor muscle and premature initiation of a normal micturition reflex
  • Strong, sudden sense of urgency, followed by involuntary leakage
Mixed incontinence
  • May have any of the clinical features above
Total incontinence
  • Complete loss of sphincter function (due to previous surgery, nerve damage, metastasis) or abnormal anatomy (fistula between urinary tract and skin)
  • Urinary leakage occurs at all times, with no associated preceding symptoms or specific trigger activity
Overflow incontinence (overflow bladder)
  • Frequent, involuntary intermittent/continuous dribbling of urine in the absence of an urge to urinate
  • Occurs only when the bladder is full
  • Often occurs with changes in position
  • Acute settings: intermittent catheterization
  • Timed voiding for day to day management
  • Treatment of underlying condition (see also “Treatment” in urinary retention)
Further causes of urinary incontinence
  • Voiding and/or storage dysfunction, intermittent voiding, urinary retention
  • Irregular, small volume incontinence without an associated urge to void (sometimes referred to as reflex incontinence)

Neural control of micturition: parasympathetic nervous systemS2–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

Additional diagnostic testing



General principles of treatment of urinary incontinence

  • Modify contributing factors (e.g., drugs) and treat reversible causes.
  • Physical measures to prevent leakage
    • Absorbent products
    • Catheterization
    • Urethral occlusion
    • Vaginal pessary (a device inserted into the vagina in order to provide more support for pelvic organs) or penile compression devices
  • Lifestyle modifications
    • 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 stress incontinence and urge incontinence.




We list the most important complications. The selection is not exhaustive.