Urinary incontinence is an underdiagnosed and underreported condition. In a study involving 2,763 postmenopausal women (mean age: 67 years), 56 percent reported urinary incontinence at least weekly.
Despite the high prevalence of urinary incontinence, fewer than one half of patients with urinary incontinence consult physicians about the problem.
Types of Urinary Incontinence
Accurate diagnosis of urinary incontinence depends on a consideration of all possible causes during the initial assessment. Most cases of urinary incontinence fall under one of the following six major subtypes:
Lack of continuity or deformity, or
Stress incontinence is the involuntary loss of urine during an increase of intra-abdominal pressure produced from activities such as coughing, laughing or exercising. The underlying abnormality is typically urethral hypermobility caused by a failure of the normal anatomic supports of the urethrovesical junction (or bladder neck). Normally, increased intra-abdominal pressure is transmitted evenly across the bladder body and neck, but when poor anatomic support allows the bladder neck to be displaced outside the abdominal cavity during such activities as coughing or laughing, a disproportionate rise in bladder pressure over urethral pressure results in urine loss. Loss of bladder neck support is often attributed to nerve, muscle and connective tissue injury occurring during vaginal delivery; however, vaginal childbirth is not the only contributing factor.
The lack of normal intrinsic pressure within the urethra, known as intrinsic urethral sphincter deficiency is another factor leading to stress incontinence. Advanced age, inadequate estrogen levels, previous vaginal surgery and certain neurologic lesions are associated with poor urethral sphincter function. The diagnosis is made by a combination of assessing the severity of leakage and conducting specialized tests such as urodynamics and cysto-urethroscopy.
Involuntary loss of urine preceded by a strong urge to void, whether or not the bladder is full, is a symptom of the condition commonly referred to as "urge incontinence." The term "overactive bladder" describes a clinical syndrome that includes not only urge incontinence, but urgency, frequency, dysuria and nocturia as well. Other commonly used terms such as detrusor instability and detrusor hyperreflexia refer to involuntary detrusor contractions observed during urodynamic studies.
|TABLE 1 - Key Questions in Evaluating Patients for Urinary Incontinence |
|Do you leak urine when you cough, laugh, lift something or sneeze? How often?*|
Do you ever leak urine when you have a strong urge on the way to the bathroom? How often?
How frequently do you empty your bladder during the day?
How many times do you get up to urinate after going to sleep?
Is it the urge to urinate that wakes you?
Do you ever leak urine during sex?
Do you wear pads that protect you from leaking urine?
How often do you have to change them?**
Do you ever find urine on your pads or clothes and were unaware of when the leakage occurred?**
Does it hurt when you urinate?§
Do you ever feel that you are unable to completely empty your bladder?