Urinary incontinence

Last updated: March 24, 2022

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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.

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.

Overview of urinary incontinence
Type of incontinence Pathophysiological mechanism Key features [3] Treatment [4]
Stress incontinence
Urge incontinence [5]
  • Strong, sudden sense of urgency, followed by involuntary leakage
Mixed incontinence
  • May have any of the clinical features above
Total incontinence
  • 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
  • Postvoid residual urine volume (seen on ultrasound or with catherization)
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)
Enuresis risoria [10]
  • Unknown; not related to stress or detrusor weakness
  • Affects children
  • Involuntary complete voiding triggered by giggling or laughing
  • Voiding behavior is otherwise normal (not a feature of enuresis).

Neural control of micturition: parasympathetic nervous systemS2S4 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

See also “Diagnostics” in “Stress incontinence” and “Urge incontinence” articles for more information.

General principles of treatment of urinary incontinence [4][5]

  • Lifestyle modifications
  • Behavioral therapies and exercises
  • Physical measures to prevent leakage
    • Vaginal pessary (a device inserted into the vagina in order to provide more support for pelvic organs) or penile compression devices
    • Absorbent products
    • Catheterization
    • Urethral occlusion
  • Management of reversible causes (e.g., constipation)
  • Topical vaginal estrogen (in postmenopausal patients with vaginal atrophy)

Medical treatment

Autonomic drugs used to treat bladder incontinence
Drug group Example drugs Mechanism of action Indication
Muscarinic antagonists
Muscarinic agonists
Alpha-1 antagonists

Other treatment options depend on the form of urinary incontinence; see the “Overview” section above as well as “Stress incontinence” and “Urge incontinence articles.

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

  1. Nitti VW. The prevalence of urinary incontinence. Rev Urol. 2001; 3 (Suppl 1): p.S2-6.
  2. Gorina Y, Schappert S, Bercovitz A, et al. Prevalence of Incontinence Among Older Americans. Vital Health Stat. 2014; 3 (36).
  3. Flesh G. Urodynamic Evaluation of Women with Incontinence. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/urodynamic-evaluation-of-women-with-incontinence.Last updated: March 7, 2016. Accessed: January 5, 2018.
  4. Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women. JAMA. 2017; 318 (16): p.1592. doi: 10.1001/jama.2017.12137 . | Open in Read by QxMD
  5. Lukacz ES. Treatment of Urinary Incontinence in Women. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/treatment-of-urinary-incontinence-in-women.Last updated: November 9, 2017. Accessed: December 13, 2017.
  6. Lukacz ES. Evaluation of Women with Urinary Incontinence. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/evaluation-of-women-with-urinary-incontinence.Last updated: November 13, 2017. Accessed: December 13, 2017.
  7. Welk B, Baverstock RJ. The management of mixed urinary incontinence in women. Canadian Urological Association Journal. 2017; 11 (6S2): p.121. doi: 10.5489/cuaj.4584 . | Open in Read by QxMD
  8. Lobo RA. Treatment of the Postmenopausal Woman. Academic Press ; 2007
  9. Kalsi V, Fowler CJ. Therapy insight: bladder dysfunction associated with multiple sclerosis. Nat Clin Pract Urol. 2005; 2 (10): p.492-501. doi: 10.1038/ncpuro0323 . | Open in Read by QxMD
  10. Stoffel JT. Detrusor sphincter dyssynergia: a review of physiology, diagnosis, and treatment strategies.. Translational andrology and urology. 2016; 5 (1): p.127-35. doi: 10.3978/j.issn.2223-4683.2016.01.08 . | Open in Read by QxMD
  11. Fernandes L, Martin D, Hum S. A case of the giggles: Diagnosis and management of giggle incontinence.. Can Fam Physician. 2018; 64 (6): p.445-447.

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