Normal VoidingWhile the bladder fills with urine, pressure remains stable due to intrinsic properties of the bladder. The ability of the bladder to maintain a stable pressure is based on natural viscoelastic properties of the bladder wall and receptors within the bladder that help it relax and accommodate as it fills. Stable pressures contribute to continence; in addition, normal anatomic pelvic support, an intact urinary sphincter and neural control of the storage and voiding process are essential.
When the bladder is full, a complex neurological process consisting of conscious and unconscious activity - allows normal voiding. Once volitionally committed to voiding, the striated sphincter relaxes followed by increasing detrusor activity leading to increased bladder pressures. Once the proximal urethra and bladder neck open, voiding begins.
In men, the bladder neck is intimately associated with the prostate and provides an additional component of continence. In women, there is no bladder neck mechanism and continence relies solely on the urethral sphincter which is composed of a layer of longitudinal intrinsic urethral smooth muscle and a larger extrinsic striated muscle that extends throughout the proximal 2/3rds of urethra. Continence therefore relies on watertight apposition of the urethral lumen and external compression of the lumen by the external muscle. Finally, adequate structural support by the pelvic floor musculature is required to keep the urethra from moving during increases in abdominal pressure.
Classification of Urinary IncontinenceIncontinence is classified into a number of categories that are not mutually exclusive:
- stress urinary incontinence
- urgency urge incontinence
- mixed (stress/urge) incontinence
- mixed symptoms
- overflow incontinence
- extraurethral incontinence
- occult/latent stress incontinence
- situational incontinence
- nocturnal enuresis
|Wein AJ, Rackley RR. Overactive bladder: a better understanding of pathophysiology, |
diagnosis and management. J Urol 2006;175:S5–10.
Stress Urinary Incontinence (SUI)
SUI refers to the involuntary leakage of urine with exertion, usually cough, sneeze or straining. On examination, leakage can be viewed with increasing abdominal pressure without bladder contractions. The etiology of SUI can be considered related to hypermobility (due to loss of strength or function of pelvic support structures) or intrinsic sphincter deficiency. Risk factors for SUI can be considered by etiology and include:
- Vaginal delivery (direct injury to pelvic soft tissues and partial denervation of pelvic floor)
- Forceps delivery
- Third-degree perineal tear
- Increased duration of labor
- High birth weight (>4000 g=8lb 13oz)
- Chronic abdominal straining
- Neurologic injury (specifically pudendal nerve injury)
- Previous urethral or periurethral surgery
- Neurologic insult
- Surgical: hysterectomy or other pelvic surgeries
- Medical: multiple sclerosis, diabetic neuropathy
- Pelvic radiation: can affect neurologic function or damage local tissues leading to poor co-aptation of the urethra
Urgency Urge Incontinence (UUI)
UUI refers to the involuntary leakage of urine accompanied by or immediately preceded by a sense of urgency. Patients often complain of frequent small losses of urine between micturitions or catastrophic leak with complete bladder emptying.
UI may be related to, but is not the same as Overactive Bladder (OAB). OAB, also known as the urgency frequency symptom syndrome, refers specifically to a clinical constellation of urgency, with or without incontinence, frequency and nocturia. Overactivity can vary in severity and symptoms among patients. Some patients demonstrate phasic detrusor activity, which describes strong contractions as the bladder fills and may or may not lead to incontinence. In contrast, terminal detrusor activity refers to a single, involuntary contraction of the bladder at maximal capacity that leads to incontinence and is most commonly seen in elderly patients or those with neurologic compromise.
Mixed Urinary Incontinence (MUI)
MUI refers to the combination of SUI and UI symptoms; a patient may have involuntary leakage with urgency AND with exertion. 40% of women with SUI will have mixed, OAB symptoms.
Other Types of Incontinence
Overflow incontinence: leakage of urine associated with urinary retention
Extraurethral incontinence: urine leakage through channels other than the urethra (e.g., fistula or ectopic ureter)
Occult/Latent stress incontinence: Masked by prolapse, evident on reduction of prolapse
Situational incontinence: coital (incontinence with sexual intercourse), giggle incontinence
Nocturnal enuresis: loss of urine occurring during sleep
Later blog entries will focus on the evaluation and management of incontinence in men and women.
 Nitti. The Prevalence of Urinary Incontinence. Rev Urol. 2001; 3(Suppl 1): S2–S6.
 Abrams P, Artibani W, Cardozo L,et al: Reviewing the ICS 2002 terminology report: the ongoing debate. Neurourol Urodyn 2009; 28: 287
 Chapple CR, Artibani W, Cardozo LD, et al. The role of urinary urgency and its measurement in the overactive bladder symptom syndrome: current concepts and future prospects. BJU Int 2005;95:335–40
Other resources for understanding incontinence include:
Chapple and Milsom. Chapter 63: Urinary Incontinence and Pelvic Prolapse in Campbell-Walsh Urology , Tenth Edition. Eds, Wein, Kavoussi, Novick, Partin, Peters. 2012.
Abrams P: ICS standardization documents. 2002
An essential resource for women with urinary incontinence and their caretakers as well. As always, the first step in treating this incontinence is to see a doctor. You don't have to be embarrassed. If you just use pads or other incontinence supplies without appropriate treatment, your condition could get worse.ReplyDelete
Thanks for your nice blog! Recently i’m promoting incontinence, wound care and bandages products named wound care . We’re selling Dignity, Molicare, Hartmann and Attends products.ReplyDelete
Urinary bender is the disability to stop urine leakage. Bender can be awkward in that it interferes with active a normal, abounding life. But there are several means to ascendancy it.ReplyDelete
was tun bei inkontinenz
Very Nice and informative Nobel Hygiene take care of yourIncontinence by their FRIENDS Diapers.ReplyDelete
Dr. Miracle Herbal Medicine Is A Good Remedy For Herpes, I Was A carrier of Herpes and I saw a testimony on how Dr. Miracle, cure Herpes, I decided to contact him, I contacted him and he guided me. I asked him for solutions and he started the remedies for my health. After he finish casting the spell, he told me to go for check up, could you believe that i was confirm herpes negative after the test, and i went to a different hospital and it was also negative, i am so happy today because i'm free from herpes disease with the help of Dr. Miracle. Thank God, now everything is fine, I'm cured by Dr.Miracle,herbal medicine, I'm very thankful to Dr. Miracle, Reach Him On (MiracleSpellHome@yahoo.com) Or WhatApp Him Or Call: +39(349)549- 4143,,, DOCTOR MIRACLE CAN AS WELL CURE THE FOLLOWING DISEASE:- (1). HERPES( 2). HIV/AIDS (3). CANCER ALL KINDS (4). Hepatitis A,B,C (5)Pregnant (6) Penis Enlargement ,,,,ReplyDelete
I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
liver already present. I started on antiviral medications which
reduced the viral load initially. After a couple of years the virus
became resistant. I started on HEPATITIS B Herbal treatment from
ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
treatment totally reversed the virus. I did another blood test after
the 6 months long treatment and tested negative to the virus. Amazing
treatment! This treatment is a breakthrough for all HBV carriers.