Urinary incontinence

Urinary incontinence is the involuntary leakage of urine.

Causes of urinary incontinence can be classified into those leading to transient incontinence and those causing established incontinence.

1. Transient incontinence

• Delirium and psychiatric disturbances may lead leaking of urine involuntarily.
• Infection, which is usually accompanied by other symptoms (urgency, dysuria).
• Atrophic urethritis or vaginitis are conditions common in postmenopausal women (due to thinning of the lining tissue due to estrogen deficiency.
• Drugs such as diuretics, calcium channel blockers, some antidepressants and ACE inhibitors may lead to incontinence. Alcohol is associated with transient incontinence.
• Depression
• Excess urinary output (such as congestive heart failure, hyperglycemia)
• Restricted mobility such as patients confined to wheelchairs.
• Stool impaction

2. Established incontinence

1. Detrusor overactivity

Neurogenic

• Stroke
• Multiple sclerosis
• Parkinson's disease
• Alzheimer's disease

Non-neurogenic

• Urethral incompetence or obstruction
• Cystitis
• Bladder stone
• Bladder carcinoma

2. Detrusor underactivity

Neurogenic

• Disk compression
• Plexopathy
• Surgical damage to the nerve supply of the detrusor muscle.
• Autonomic neuropathy (e.g. diabetes, alcoholism, vitamin B12 deficiency).

Non-neurogenic

• Idiopathic (common in women)

3. Urethral obstruction

• Prostatic enlargement
• Prostatic carcinoma
• Cystocele

4. Urethral incompetence

• Radical prostatectomy
• Stress urinary incontinence (SUI) types 1, 2 and 3. SUI types 1 and 2 are associated with urethral hypermobility, while SUI type 3 is associated with urethral incompetence.

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