Urinary incontinence

Definition

• Urinary incontinence: Involuntary loss of urine.

Types

• Stress incontinence: Loss of urine during physical exertion such as coughing, sneezing, or exercise.
• Urge incontinence (Overactive bladder): Sudden, intense urge to urinate followed by involuntary loss of urine.
• Mixed incontinence: Combination of stress and urge incontinence.
• Overflow incontinence: Inability to empty the bladder completely, leading to dribbling.
• Functional incontinence: Physical or mental barriers preventing reaching the toilet in time.

Epidemiology

• More common in females, especially post-menopausal women.
• Prevalence increases with age.

Causes

• Stress incontinence: Weakened pelvic floor muscles, often due to childbirth or surgery.
• Urge incontinence: Bladder muscle (detrusor) overactivity, idiopathic or due to conditions like UTIs, bladder stones, or neurologic disorders.
• Overflow: Blockage or obstruction of the bladder, weak bladder muscle.

Investigations

• History and examination: To determine type of incontinence.
• Urine dipstick: Rule out infection or hematuria.
• Bladder diary: Record timings and amounts of urine leakage.
• Urodynamic testing: Assesses bladder and sphincter function.
• Cystoscopy: To view inside of bladder.

Management

• Lifestyle interventions: Weight loss, fluid management, avoiding irritants like caffeine.
• Pelvic floor exercises (Kegel exercises): Especially for stress incontinence.
• Medications: Anticholinergics, Mirabegron for urge incontinence.
• Surgical treatments: For stress incontinence – tape procedures, colposuspension; For overflow incontinence – catheterisation.

Complications

• Impact on quality of life.
• Skin problems due to moisture.
• Urinary tract infections.