Description

• 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
• Continuous incontinence: continuous leakage of urine; leakage without awareness.

Epidemiology

• Overall prevalence: Studies have shown prevalence rates as high as 44–57% in middle-aged and postmenopausal women (1). Of these, one-third of the cases were classified by women as moderate to severe and one-quarter of these women feel the symptoms affect their daily lives.
• Underreporting by women is likely. A survey of U.S. women found only approximately 45% of women experiencing these symptoms brought them up to their healthcare provider, underscoring the importance of screening for these conditions (1).

Etiology and Pathophysiology

• Stress incontinence: occurs with increased intra-abdominal pressure. There are two types of stress incontinence: anatomic, which is due to urethral hypermobility from lack of pelvic support, and intrinsic sphincter deficiency (ISD), which is impaired closure of urethra secondary to surgical scarring, radiation, or hormonal and age-related changes.
• Urge incontinence: may be due to detrusor overactivity, neurologic causes (such as spinal cord injury), or idiopathic
• Overflow incontinence: detrusor underactivity (“neurogenic bladder”) or bladder outlet obstruction. Bladder outlet obstruction could be caused by fibroids, pelvic organ prolapse, and less commonly masses/tumors.
• Mixed incontinence: combination of urgency and stress incontinence features.
• Continuous incontinence: constant involuntary 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.

Risk Factors

Advanced age, menopause/vaginal atrophy, impaired functional status, obesity (BMI >30), diabetes mellitus, parity, vaginal childbirth, pelvic surgery or radiation, urethral diverticula, pelvic organ prolapse, neurologic disease such as stroke, smoking, chronic obstructive pulmonary disease (COPD), cognitive impairment, constipation, caffeine, high impact exercises, and pelvic floor dysfunction

General Prevention

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