Urinary incontinence: the involuntary loss of urine, which is objectively demonstrable and is a social or hygienic problem

Pathophysiology

Ageing changes which contribute to urinary incontinence

• As we age, bladder capacity and urethral closure pressure decrease
• At the same time, post void residue and detrusor overactivity increase

Transient causes of incontinence

• Delirium
• Infection - urinary (symptomatic)
• Atrophic urethritis/vaginitis
• Pharmaceutical/prostate
• Psychological, especially depression
• Endocrine (or excess fluid intake/output)
• Restricted mobility
• Stool impaction

Classification of incontinence

• Stress: involuntary urinary leakage on effort or exertion, sneezing or coughing
• Urge: involuntary leakage accompanied by or immediately preceded by urgency
• Mixed: involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing
• Overflow: leakage owing to bladder outflow obstruction of any cause resulting in large post-void residual volume

Clinical features