Incontinence, Urinary Adult Female

Description

• Stress UI: increased intra-abdominal pressure (coughing, exertion); most common in younger women
• Urge UI: sudden uncontrollable ur loss, preceded or accompanied by urgency; from overactive bladder (OAB) or detrusor overactivity (DO); most common in older adults
• Mixed UI: >1 type of UI, often a combo (stress and urge UIs); overall most common type
• Overflow UI: high-residual volume from inadequate bladder emptying (chronic ur retention), causing frequent dribbling; predisposes to recurrent infections, vesicoureteral reflux, autonomic dysreflexia
• Functional UI: ur loss due to deficits in cognition or mobility with normal ur system function
• Continuous UI: sustained slow leakage in between regular voiding; may have no awareness nor bladder fullness

Epidemiology

Prevalence

• Overall prevalence in women: 10–20% (up to 77% in nursing homes)
• In women, stress UI decreases with age, whereas urge UI increases.

Etiology and Pathophysiology

• Stress UI: 2 types—anatomic (urethral hypermobility from lack of pelvic support) and intrinsic sphincter deficiency (impaired urethral closure); stress UI is secondary to surgical scarring, radiation, hormonal, or age-related changes.
• Urge UI: DO (usual cause) or OAB from neuro causes (SCI), abd trauma, infection, Rx, certain fluids, or idiopathic; DO could be idiopathic or neurogenic (MS).
• Overflow UI: detrusor underactivity (“neurogenic bladder”), increased bladder ur volume (DM or Rx), or bladder outlet obstruction (fibroids, pelvic organ prolapse [POP], masses)
• Mixed UI: aggregate of etiologies from each type of UI present
• Functional UI: cognitive impairment (dementia, delirium, intellectual disabilities); unable to recognize need for toilet; psychological issues and mental illness (decreased awareness); medical conditions (arthritis) and physical disability impairing mobility; poor vision; and environmental barriers
• Continuous UI: constant involuntary ur loss; ectopic ureters in females usually open in urethra distal to sphincter or in the vagina, causing sustained leakage through the urethra or extra-urethral (urogenital fistulas: vesicovaginal [most common], ureterovaginal, and urethrovaginal).

Risk Factors

Advanced age, vaginal atrophy (menopause), impaired cognition-function, obesity (BMI >30), medical conditions (DM, chronic obstructive pulmonary disease [COPD]), multiparity, pelvic floor dysfunction (vaginal birth, pelvic surgery or radiation), urethral diverticula, POP, neuro diseases (stroke, MS, Parkinson disease), smoking, constipation, caffeine, and high-impact exercises