Urinary incontinence
Definition The involuntary loss of urine caused by either bladder or urethral sphincter dysfunction.
Types Stress I. Urge I. Overflow I. Total I.
Abnormal
connection
between the
urinary tract
Mechanism and the skin
(fistula)
Outlet incompetence Detrusor overactivity leak Incomplete emptying
(urethral hypermobility or with urge to void immediately (detrusor underactivity or
intrinsic sphincter outlet obstruction)
deficiency)
multiparous women or
Bladder irritation from UTI,
RF pelvic surgery diabetes, spinal
stones, tumors, pelvic
Obesity, pregnancy, vaginal cord injury
radiation
delivery,
Loss with + intra-abdominal Strong, unexpected urge to void Dribbling experienced after Uncontrolled
CP pressure (eg, coughing, unrelated to position or incomplete emptying of loss at all times
sneezing, lifting) activity Bladder. and in all
May be “wet” (with leakage) positions
or “dry” (without leakage).
Pelvic floor muscle Pelvic floor physical therapy, Catheterization, relieve Surgery
strengthening (Kegel) bladder training (timed obstruction
exercises, weight loss, voiding, distraction or Placement of urethral
Tx. Pessaries relaxation techniques), catheter in acute
Urethral sling procedure antimuscarinics (eg, settings
oxybutynin for overactive Treatment of underlying
Mixed UI: bladder), diseases
features of both stress and 2nd line BA mirabegron/ Timed voiding/catheterization
urgency. vibegron
In healthy women, the bladder Loss
neck is supported above the of bladder neck support results
pelvic floor and increases in in descent of the bladder neck
abdominal pressure are and
transmitted to the bladder neck loss of pressure transmission,
resulting in leaking when
coughing,
straining, etc, (stress
incontinence)
Personal data Name, age, married ?
CC+ PI severity, triggers, frequency
Family Hx.
History
Past M. + S. Pelvic surgery , UTI , DM , spinal cord injury
Obstetric /GYN Multiparous ? Delivery ?
Drug Hx. Radiation ?
Social Hx. -
General exam General look
Regional exam Head & Neck \ UL + LL \ Abdominal
Examination
Pelvic Prolapse , pelvic floor
- Urinalysis, culture.
Investigation - Ultrasound for residual urine (>50 ml abnormal).
- Bladder diary, pad test (not routine).
- Urodynamic studies (if conservative management fails).
Conservative (first-line):
- Lifestyle: caffeine reduction, fluid modification, weight loss.
- Pelvic floor muscle training (PFMT), physiotherapy, vaginal cones, electrical
[Link] products.
Mangement Pharmacologic:
• Stress UI: Imipramine, Duloxetine, urethral bulking agents.
• Urgency UI/OAB: Anticholinergics (Oxybutynin, Tolterodine).
Surgical:
• Stress UI: Tape procedures (TVT, TOT), sling procedures, colposuspension.
• UI: Botulinum toxin injections.
• Mixed UI: combination of drugs + surgery.
Urinary Fistulas (True Incontinence)
Types :
vesico-vaginal, uretero-vaginal.
Causes :
post-hysterectomy (most common in developed countries), pelvic radiation,
obstetric complications (in developing countries).
Diagnosis :
dye tests, cystoscopy, IVP, labs.
Treatment:
Early fistulas (3–7 days): immediate repair.
Late fistulas: wait 3–4 months unless severe; surgical repair
(transvaginal/transabdominal).
Small fistulas: trial of catheter drainage.