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Urinary Incontinence

Urinary incontinence involves the involuntary leakage of urine. The types of urinary incontinence can be categorized into stress, urge, functional, mixed, and overflow incontinence. While younger adults can be affected by this condition, it is more prevalent in elderly adults. Patients with mixed urinary incontinence present with a combination of stress and urge urinary incontinence symptoms. This can occur from urethral sphincter and pelvic floor weakness or detrusor overactivity. Bladder irritation and loss of neurologic control are associated with urge urinary incontinence. Overflow urinary incontinence occurs due to an overdistended bladder and is common in men with benign prostatic hyperplasia. Functional urinary incontinence may result from physical barriers to toileting. Patients that are pregnant or have given birth, have diabetes, or have a high body mass index are at an increased risk of incontinence.

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Ep 182 Evaluating Female Urinary Incontinence: Essential Steps for the Generalist with Dr. Sarah Boyles

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Urinary Incontinence Diagnosis

Voiding diaries are useful in the diagnosis of incontinence, and a patient’s history will help specify the type of urinary incontinence. A brief questionnaire of the 3 Incontinence Questions (3IQ) is helpful in distinguishing between incontinence and other causes of urine leakage. A physical exam should be performed, and in some cases, a cough stress test and cotton swab test are useful. Additionally, in women, a gynecologic history should be taken and estrogen status should be determined. During perimenopause, atrophic vaginitis and urethritis can contribute to reversible urinary incontinence. Laboratory tests are not always necessary, but they are beneficial for ruling out other conditions.

Urinary Incontinence Podcasts

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Urinary Incontinence Treatment

Treatment and management of incontinence varies with the type of urinary incontinence. For stress urinary incontinence, behavioral therapy, electrical stimulation, and pelvic floor muscle strengthening are common forms of conservative management while alpha-adrenergic agonists are used as a pharmaceutical therapy. Surgical management consists of intravesical balloons, sling procedures, or urethropexy. Urge urinary incontinence does not use mechanical devices, but is otherwise managed similar to stress incontinence. Antimuscarinics are used for pharmacological management. Overflow urinary incontinence is treated with clean intermittent catheterization, alpha-adrenergic antagonists, or a suprapubic catheter. To treat functional urinary incontinence, underlying cognitive causes should be addressed.

Urinary Incontinence Articles

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Urinary Incontinence Demos

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Urinary Incontinence Tools

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References

[1] Tran, L. N., & Puckett, Y. (2021, August 11). Urinary incontinence. StatPearls [Internet]. Retrieved November 10, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK559095/

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