Incontinence, Urinary Adult Female

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  • Urinary incontinence: involuntary loss of urine
  • Stress incontinence: associated with increased intra-abdominal pressure, such as coughing, laughing, sneezing, or exertion
  • Urge incontinence: sudden uncontrollable loss of urine, preceded or accompanied by urgency, or a sudden compelling desire to urinate that is difficult to delay. Urge incontinence may be associated with overactive bladder or detrusor overactivity.
  • Mixed incontinence: loss of urine from a combination of stress and urge incontinence
  • Overflow incontinence: high residual or chronic urinary retention leading to urinary spillage from an overdistended bladder
  • Functional incontinence: loss of urine due to deficits of cognition and/or mobility
  • Total incontinence: continuous leakage of urine; leakage without awareness


  • Overall prevalence—38% of women age >60 years. A 2012 survey showed stress incontinence affected 37.5% of women age 30 to 50 years (1).
  • Prevalence in women >75 years is 75%, and 6% of nursing home admissions are directly attributable to incontinence (2).

Etiology and Pathophysiology

  • Stress incontinence: occurs with increased intra-abdominal pressure. Two types:
    • Anatomic: due to urethral hypermobility from lack of pelvic support
    • Intrinsic sphincter deficiency (ISD): impaired closure of urethra. Urethral mucosal seal and inherent closure from collagen, fibroelastic tissue, and smooth and striated muscles may be lost secondary to surgical scarring, radiation, or hormonal and age-related changes.
  • Urge incontinence: may be due to detrusor overactivity or may be idiopathic
  • Overflow incontinence: urinary retention (usually from neurogenic bladder)
  • Total incontinence: constant loss of urine. Ectopic ureters in females usually open in the urethra distal to the sphincter or in the vagina, causing continuous leakage; may also occur with fistulous connections between bladder, ureters, or urethra and vagina or uterus
  • Women with urge urinary incontinence report poorer quality of life than those with stress incontinence (2).

Risk Factors

Advanced age, impaired functional status, obesity (BMI >30), history of gestational diabetes, pregnancy, vaginal childbirth, pelvic surgery or radiation, urethral diverticula, genital prolapse, smoking, chronic obstructive pulmonary disease (COPD), cognitive impairment, constipation, caffeine, and pelvic floor dysfunction

General Prevention

Obesity and caffeine avoidance, smoking cessation, high-fiber diet to reduce constipation

Commonly Associated Conditions

Pelvic organ prolapse, UTI, COPD, diabetes mellitus, neurologic disease, obesity, chronic constipation, depression, low libido, dyspareunia, and any disease that results in chronic cough

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