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URINARY INCONTINENCE
Urinary incontinence is the complaint of involuntary urine leakage.
Stress urinary incontinence is the involuntary urine leakage on effort or exertion or when coughing or sneezing.
Urge urinary incontinence is the one associated with or immediately preceded by urgency.
Mixed urinary incontinence is the involuntary urine leakage associated with both urgency and with exertion, effort, coughing or sneezing.

Definition

Urinary Incontinence (UI)

  • Complaint of involuntary urine leakage

Stress Urinary Incontinence

  • Involuntary urine leakage on effort or exertion or when coughing or sneezing
  • Occurs during increased intraabdominal pressure that overcomes sphincter mechanism in the absence of bladder contraction
  • Irritative voiding symptoms & nocturia are absent
  • May be caused by poor pelvic support or intrinsic sphincter deficiency
  • Stress urinary incontinence in men is primarily associated w/ surgery of the prostate

Urge Urinary Incontinence

  • Involuntary urine leakage due to detrusor overactivity, associated w/ or immediately preceded by urgency
  • Patients are unable to hold back their urine when they feel the intense need to void
  • May be caused by detrusor myopathy, neuropathy, bladder CA, stones or infections

Mixed Urinary Incontinence

  • Involuntary urine leakage associated w/ both urgency & w/ exertion, effort, coughing or sneezing
  • Present when the bladder outlet is weak & detrusor is overactive

Overflow Incontinence

  • Also referred to as “incomplete emptying”, which describes the dribbling or continuous leakage associated w/ incomplete bladder emptying
  • May be caused by bladder overdistention, impaired detrusor contraction &/or bladder outlet obstruction
  • Associated symptoms include weak urinary stream, intermittency, hesitancy, frequency & nocturia

Incontinence related to reversible medical conditions

  • Transient incontinence
    • Arises from an acute medical condition affecting the lower urinary tract
    • Symptoms resolve when the medical condition is addressed & treated
  • Functional incontinence
    • Arises from chronic impairment of physical &/or cognitive functioning
    • Diagnosis of exclusion
    • Symptoms may resolve by improving patient’s functional status, treating comorbidities & changing medications

Overactive Bladder (OAB) Syndrome

  • Urgency w/ or w/o urge incontinence usually accompanied w/ complaints of frequency & nocturia

Risk Factors

Risk Factors for Urinary Incontinence (UI)

  • Irreversible factors
    • Increasing age, race, educational attainment, family history, childhood nocturnal enuresis or daytime wetting, multiparity, forceps delivery, menopause, hysterectomy, surgery for pelvic organ prolapse
  • Reversible factors
    • Body mass index >30, smoking, high caffeine intake, participation in high-impact sports, diabetes, depression, CNS disorders, recurrent UTI, constipation, drugs, pelvic organ prolapse, environmental barrier
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