Key Points
ÎUrinary incontinence is very common, occurring in one of every two women depending upon their age.
ÎThe majority of urinary incontinence is classified as urge, stress, or a combination of both symptoms– "mixed."
ÎThe mainstay of treatment for urge incontinence is lifestyle modification, behavioral therapy and anticholinergic medication. Side effects and limited efficacy compromise symptom management in at least a third of women.
ÎPelvic floor strengthening with Kegel exercises improves the symptoms of urge and stress incontinence.
ÎModerate to severe stress urinary incontinence is most effectively treated with mid-urethral slings.
Table 1. Types of Urinary Incontinence in Women Type
Etiology
Urge Incontinence
> Detrusor hyperactivity > Aging > Loss of CNS
> Local bladder irritation (eg, infection, tumor, foreign body)
inhibitory pathways
> Bladder outlet obstruction (prior incontinence surgery, prolapse)
Stress Incontinence
> Poor pelvic support of urethra
> Large volume of urine often associated with urgency
> Report of urgency, frequency, pressure
> Urgency and incontinence triggered by cues (eg, running water, cold weather, sight of bathroom or house)
> Nocturia (> 2×/night)
> Small volume leakage with increase in abdominal pressure, such as during coughing, sneezing, strenuous exercise
Clinical Presentation Risk Factors
> Increasing age > Dementia > Poor functional status > Stroke and cervical spine stenosis
> History of urethral suspension or sling procedure
> Bladder irritants (eg, caffeine, nicotine, foreign body)
> Childhood enuresis
> More common than urge incontinence in younger women
> Vaginal delivery, forceps delivery
> Increased parity > Increased BMI > Chronic increased
> Incomplete closure of urethra due to neuromuscular atrophy or scarring (intrinsic sphincter deficiency)
Mixed Incontinence
Other > Detrusor atony
> Urinary tract-vaginal fistula
> Continuous dribbling > May result in cumulative large volume leakage
abdominal pressure (eg, pulmonary disease, constipation)
> Pelvic irradiation or surgery
Combination of urge and stress incontinence
> High post-void residual volumes
> Continuous dribbling > Neurologic disease
> Pelvic surgery > Pelvic radiation
