Common Types of Urinary Incontinence

COMMON TYPES OF URINARY INCONTINENCE

STRESS URINARY INCONTINENCE

Stress urinary incontinence occurs when the bladder sphincter is weak and ceases to function efficiently due to weakness of the muscles in the pelvic floor.  In women, stress incontinence is often first reported during pregnancy or after childbirth.  Hormonal changes during the menopause can aggravate the situation, as may obesity.  In stress urinary incontinence, the function of the urethra and bladder sphincter is impaired because of the inadequate support received from the muscles in the pelvic floor.

Stress urinary incontinence is the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing.  If there is a rise in intra-abdominal pressure, the pressure on the bladder also rises, and can overcome the closure pressure of the sphincter, resulting in involuntary urine loss.

Stress urinary incontinence may be classified as slight, moderate or severe.  In patients with severe stress urinary incontinence, leakage can occur with minimal movement.  This type of incontinence occurs mainly in women.

URGE URINARY INCONTINENCE

Urge urinary incontinence is the complaint of involuntary leakage accompanied by or immediately preceded by urgency (ICS 2002).

Urge incontinence is caused by over activity of the bladder muscles, which may result in the sudden, spontaneous, partial or complete emptying of the bladder when an acute urge to void develops.

In less severe cases, the symptoms are those of a persistent urge to pass urine frequently, with the patient retaining voluntary control.  As the symptoms increase in severity, the urge to void can no longer be controlled voluntarily and incontinence results.

Urge incontinence may be associated with urinary tract infection, enlargement of the prostate gland, metabolic diseases such as diabetes, or degenerative diseases of the central nervous system.  In the elderly, urge urinary incontinence is the type of incontinence most commonly seen.

 NEUROGENIC DETRUSOR OVERACTIVITY

Neurogenic detrusor over activity occurs in patients with relevant neurological conditions and is characterised by the onset of spontaneous, uninitiated, detrusor (bladder muscle) contractions, with or without the sensation of urgency, leading to urinary incontinence. With all neurogenic bladder dysfunction, urodynamic investigation is essential to determine the functioning of the detrusor and sphincter.

Neurogenic detrusor over activity can be caused by spina bifida, spinal cord injury, tumours, multiple sclerosis, Parkinson’s disease, stroke or dementia.

INCONTINENCE ASSOCIATED WITH BLADDER OUTLET OBSTRUCTION

An obstruction to the outflow tract, such as a stricture or stenosis in the urethra, or an enlarged prostate gland in the male patient, can result in urinary incontinence previously described as ‘overflow incontinence’.

As a result of this partial blockage of the urethra, difficulty is experienced passing urine and the bladder may not empty completely.  Over time, chronic retention of urine results and a large volume of urine accumulates in the bladder. Chronic retention of urine is defined as a non-painful bladder, which remains palpable after the patient has passed urine (ICS 2002).  As a result there may be incontinence, which may be intermittent or may be described as a constant dribble.

Acute retention of urine is defined as a painful, palpable bladder, when the patient is unable to pass any urine (ICS 2002).  This is a medical emergency.

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