Coital incontinence: Loss of urine during sexual intercourse
Functional incontinence: Incontinence in the setting of physical/cognitive impairment that limits mobility or the ability to process information about bladder fullness (eg. hip fracture or dementia)
Urinary incontinence is considered a stigmatizing condition in most populations, which contributes to low rates of presentation for care and creates a high risk for respondent bias in observational studies.
Nearly 35% of women older than 40 years of age have urinary incontinence
Sympathetic nervous system: Predominates during the storage phase and maintains continence through the paravertebral ganglia, the hypogastric nerves and hypogastric plexus.
Parasympathetic system: Coordinates the voiding phase, through the sacral plexus and pelvic nerves (S2–S4). Afferent signals from the urothelium and bladder wall are transmitted through to the thalamus; the balance between storage and voiding is maintained by the central pontine micturition centre
The endopelvic fascia (fibromuscular connective tissue of vagina) creates a ‘hammock’ against which the urethra is compressed during rest and activity. This compression, combined with ‘intrinsic’ urethral sphincter pressure and mucosal coaptation, effectively closes the urethral lumen and prevents the involuntary loss of urine even when the intravesical pressure increases.
Voiding up to 7 times/day in waking hours is considered normal, with micturition volume of 250–300 ml/void
Stress urinary incontinence:
Urethral hypermobility: Resulting from loss of support of the bladder neck & urethra “hammock hypothesis” (such that they move during peaks of abdominal pressure)
Excess loading from obesity, chronic cough, constipation, parturition or menopause
Intrinsic sphincter deficiency: Weakness of urinary sphincter itself
Can result from trauma, repeated urogynaecological surgeries, neurological disease, ageing or diseases leading to systemic muscular atrophy
Urgency urinary incontinence:
Detrusor overactivity: Common after spinal injuries, with substantial spinal disease from multiple sclerosis or other lesions of the central nervous system
Poor detrusor compliance: After pelvic radiotherapy, or prolonged catheterization.
3 Incontinence Questions (3IQ):
Simple, quick, and noninvasive test with acceptable accuracy for classifying urge and stress incontinence
Cough stress test
Urethral leakage provoked by a series of forceful coughs in supine/standing position with a comfortably full (~300 ml) bladder volume
Valsalva manoeuvre: For pelvic organ prolapse
Forced attempted exhalation against a closed airway over ≥6 seconds in whichever position maximum protrusion is best demonstrated (supine, left lateral or standing).
Recommended as a screening tool for UTIs and other associated conditions in the assessment of urinary incontinence
Revised McGreer criteria for diagnosing UTIs recommended
Post-void residual volume (PVR) assessment:
Determined by measuring the volume remaining in the bladder immediately after voiding as a measure of the completeness of bladder emptying
Via ultrasonography, with either a bladder scanner or formal renal tract imaging, or an in–out catheter.
Three types of urinary diary can be used: a micturition chart to record the timing of each void, a frequency–volume diary to record the volume voided with the time and a bladder diary to record additional information on urinary incontinence episodes, pad usage, fluid intake, fluid type and sensation of urgency
Absorbent perineal pad worn for up to 24 hours while conducting a range of normal activities designed to replicate the usual provocations of urinary incontinence, such as walking and exercising
Series of investigations assessing lower urinary tract function that include uroflowmetry, voiding cystometry, filling cystometry, urethral function and provocative manoeuvres to demonstrate urinary incontinence
Urge urinary incontinence (UUI)
Anticholinergic drugs: Oxybutynin, tolterodine
Sacral nerve stimulation
Stress urinary incontinence (SUI):
Kegel (pelvic floor) exercises with or without biofeedback