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Urinary Incontinence

Incontinence is a symptom that presents in a limited number of clinical patterns, each having several possible causes.

Pathophysiology

Stress Urinary Incontinence is characterized by loss of urine with exertion, coughing, jumping, and other physical activities. It is caused by weakness of the pelvic floor muscles, and it is most common in women with overactive bladder.

Detrusor Instability (Urge Incontinence) is characterized by spontaneous, uninhibited bladder contractions or spasms. The disorder is usually idiopathic, and it is most common in older, post-menopausal women. Detrusor instability is the most common type of incontinence,

Overflow Incontinence

Overflow incontinence is caused by overdistention of the bladder. Dribbling is especially common; however, urgency and stress symptoms may

The bladder may become distended as a result of detrusor inadequacy (as in diabetes) or because of physical obstruction urinary incontinence, urine leakage, urine leak (prostate hyperplasia in men).

Iatrogenic Incontinence. The most urinary incontinence, overactive bladder, urine leakage, urine leak common causes are use of antipsychotics, antihistamines, antidepressants, decongestants, diuretics, sedative-hypnotics, and antihypertensives (alpha-blockers).

Other causes of incontinence include loss of intrinsic urethral tone, detrusor muscle hypotonicity, delirium, urinary tract infection, psychiatric disorders, endocrine disorders, and stool impaction incontinence

        Types of Urinary Incontinence
        Type of urinary incontinence Symptoms Mechanism Common Causes
        Detrusor instability (urge incontinence) Urgency (strong desire to void) Uninhibited detrusor contractions Not caused by any neurologic deficit
        Stress Incontinence Involuntary loss of urine during coughing, sneezing, lifting Intrinsic sphincter deficiency. Hypermobility of bladder neck, altered angle between urethra and bladder base Obstetrical trauma, neurologic lesion,

        pelvic muscle relaxation
        Overflow Incontinence Dribbling, urgency, stress Acontractile or underactive detrusor; outlet obstruction Diabetes, drugs, fecal impaction.

        In men: prostate disease

        In women: anti-incontinence surgery, cystocele

Clinical Evaluation and Treatment of Incontinence

The characteristics of the incontinence  is assessed (on way to bathroom).