Urinary Incontinence

Urinary incontinence is a disorder that arises when urine leakage occurs from the bladder without warning or control. It may be caused by a lack of sphincter muscles, medication side effects, or physical conditions such as dementia or Parkinson's disease. Urinary incontinence is classified into type 1 and type 2. In terms of severity, grade 3 and 4 usually represent more severe cases due to the inability to control urinary leakage while standing and walking. Bladder training, pelvic floor muscle exercises, or surgical options are typical treatments.

The classification of urinary incontinence is based on the frequency and the severity of the urine leakage. The most extreme cases are known as "urgency" urinary incontinence or "complete" urinary incontinence. Urgency urinary incontinence is categorized as either urge or mixed urge and stress. In urge incontinence, there is a sudden, strong desire to urinate with an inability to delay urination long enough to reach a bathroom facility in time. Mixed urge and stress incontinence is characterized by a sudden urge to urinate and an awareness that bladder control will be compromised if immediate action is not taken. Urgency urinary incontinence is a more severe condition that results in the inability to control the bladder and resulting leakage of urine. Urinary incontinence in which no leakage occurs during normal daily activities is called "overflow" urinary incontinence.

Urine leakage caused by increased intra-abdominal pressure (IAP) associated with coughing, sneezing, lifting heavy objects, or straining during bowel movements due to metabolic disorders such as diabetes is known as stress urinary incontinence.

Stress incontinence may be caused by a weak pelvic floor or possibly even have been caused by prior surgery on the pelvic floor. Treatment involves strengthening exercises and wearing an appropriate protective pad for the specific goal.

Urinary incontinence following childbirth is known as post-partum urinary incontinence. It is a temporary loss of bladder control caused by trauma to the muscles and nerves of birth, which affect the tone of the neuromuscular sphincter at the level of the pubococcygeal (pc) muscle. This mechanism works primarily by increasing intra-abdominal pressure, thus increasing urethral pressure and flow resistance.

Urinary incontinence may also occur in people who have a neurological disorder such as Parkinson's disease or dementia or those taking medications with anticholinergic side effects. The treatment depends on whether a person can be helped or not. Surgery of the bladder or pelvic floor is known as "neurogenic" or "reflex" urinary incontinence. The symptom onset is often gradual and can be so slight that patients may not initially realize they have a problem.

Urinary incontinence after bariatric procedures, such as gastric bypass surgery and laparoscopic adjustable gastric banding, is called "bariatric" urinary incontinence. This type of urinary incontinence can be challenging to diagnose and can result in significant functional disabilities for the patient.

Treatment of urinary incontinence may include the use of medications to relax the sphincter muscles. Such drugs are known as anticholinergics or anticholinesterase agents.

Other treatment options include pelvic floor exercises, bladder retraining (also known as pelvic floor muscle training), or surgery to repair weak pelvic floor muscles. The use of a spacer device, such as a device called the "functional diaper," may be helpful in retaining urine during times of increased intra-abdominal pressure caused by coughing or laughing.

Most patients experience significant improvement after treatment because urinary incontinence is typically treated with several different techniques simultaneously.