Key Points
ÎÎUrinary incontinence is very common, occurring in one of every two women
depending upon their age.
ÎÎThe majority of urinary incontinence is classified as urge, stress, or a
combination of both symptoms– "mixed."
ÎÎThe 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.
ÎÎPelvic floor strengthening with Kegel exercises improves the symptoms of
urge and stress incontinence.
ÎÎModerate to severe stress urinary incontinence is most effectively treated
with mid-urethral slings.
Table 1. Types of Urinary Incontinence in Women
Type
Etiology
Clinical Presentation
Risk Factors
Urge
Incontinence
>> Detrusor hyperactivity
>> Aging
>> Loss of CNS
inhibitory pathways
>> Local bladder
irritation
(eg, infection, tumor,
foreign body)
>> Bladder outlet
obstruction
(prior incontinence
surgery, prolapse)
>> 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)
>> Increasing age
>> Dementia
>> Poor functional status
>> Stroke and cervical
spine stenosis
>> Bladder irritants
(eg, caffeine, nicotine,
foreign body)
>> History of urethral
suspension or sling
procedure
>> Childhood enuresis
Stress
Incontinence
>> Poor pelvic support
of urethra
>> Small volume leakage
>> More common than
with increase in
urge incontinence in
abdominal pressure,
younger women
such as during coughing, >> Vaginal delivery,
sneezing, strenuous
forceps delivery
exercise
>> Increased parity
>> Increased BMI
>> Chronic increased
abdominal pressure
(eg, pulmonary
disease, constipation)
>> Continuous dribbling
>> Pelvic irradiation or
>> May result in cumulative
surgery
large volume leakage
>> Incomplete closure
of urethra due to
neuromuscular
atrophy or scarring
(intrinsic sphincter
deficiency)
Mixed
Incontinence
Other
Combination of urge and stress incontinence
>> Detrusor atony
>> Urinary tract-vaginal
fistula
>> High post-void residual
volumes
>> Continuous dribbling
>> Neurologic disease
>> Pelvic surgery
>> Pelvic radiation
