Urinary incontinence

Urinary incontinence (UI) is a common problem, affecting around 4-5% of the population. It is more common in elderly females.

Risk factors

• advancing age
• previous pregnancy and childbirth
• high body mass index
• hysterectomy
• family history

Classification

• overactive bladder (OAB)/urge incontinence
  • due to detrusor overactivity
  • the urge to urinate is quickly followed by uncontrollable leakage ranging from a few drops to complete bladder emptying
• stress incontinence: leaking small amounts when coughing or laughing
• mixed incontinence: both urge and stress
• overflow incontinence: due to bladder outlet obstruction, e.g. due to prostate enlargement
• functional incontinence
  • comorbid physical conditions impair the patient's ability to get to a bathroom in time
  • causes include dementia, sedating medication and injury/illness resulting in decreased ambulation

Initial investigation

• bladder diaries should be completed for a minimum of 3 days
• vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles ('Kegel' exercises)
• urine dipstick and culture