Urinary incontinence overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Urinary incontinence: Unintentional loss of urine. Inability to hold urine in the bladder due to loss of voluntary control over the bladder (detrusor) muscle and/or urinary sphincters resulting in the involuntary passage of urine. In this article, the term “incontinence” will be used to mean urinary incontinence. See also fecal incontinence.

Urinary incontinence can be broadly classified into 5 major types. They are stress incontinence, urge incontinence, overflow incontinence, mixed incontinence, functional incontinence.

Urinary incontinence is commonly caused by conditions affecting bladder integrity, including infections, neoplasms, surgical procedures, and internal sources of trauma, such as nutrition and water intake. It can also be caused by congenital and acquired neurological, muscular, and renal conditions.

Continence and micturition involve a balance between outlet (urethra) and bladder detrusor muscle activity. Lower urinary tract function is often divided into filling and voiding phases. Normally as the bladder fills the detrusor is compliant – stretching and increasing the volume it holds – without any unpleasant sensation and the outlet is closed. At a socially acceptable time and place to void the bladder (detrusor) contracts and the outlet relaxes and flow ensues. Any perturbation in that balance can lead to voiding dysfunction or incontinence. Abnormal detrusor muscle activity or hypersensitivity of the bladder can lead to urge incontinence. An incompetent outlet can lead to stress incontinence. A bladder that cannot contract may lead to overflow incontinence.

Urinary incontinence may have different etiologies depending upon the underlying dysfunction. The various types of urinary incontinence should be differentiated from each other and also urinary incontinence should be differentiated from other conditions like stroke, multiple sclerosis, parkinson’s disease, fecal impaction, rectal prolapse etc.

Common complications of urinary incontinence include increased risk of falling and fractures, urinary tract infection, sleep disorders, depression. The prognosis associated with urinary incontinence depends on the underlying cause and associated conditions such as accurate diagnosis, and proper treatment.

The physical examination will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.

Medications can reduce many types of urine leakage. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage. And some, especially hormones such as estrogen, are believed to cause muscles involved in urination to function normally.In vaginal atrophy – topical or vaginal estrogens; tolterodine, oxybutynin, propantheline, darifenacin, solifenacin, trospium in urge incontinence, imipramine in mixed and stress urinary incontinence, pseudoephedrine and duloxetine in stress urinary incontinence

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