Urinary Incontinence
PROBLEM MECHANISMS SYMPTOMS PHYSICAL SIGNS
STRESS INCONTINENCE
The urethral sphincter is In women, pelvic floor Momentary leakage of small Stress incontinence may be
weakened so that transient weakness and inadequate amounts of urine with demonstrable, especially if
increases in intra-abdominal muscular and ligamentous coughing, laughing, and the patient is examined
pressure raise the bladder support of the bladder neck sneezing while the person is in before voiding and in a
pressure to levels that and proximal urethra change an upright position. Urine loss is standing position.
exceed urethral resistance. the angle between the bladder unrelated to a conscious urge
and the urethra to urinate. Atrophic vaginitis may be
Causes include childbirth and evident. Bladder distention is
surgery. Local conditions absent.
affecting the internal urethral
sphincter, such as
postmenopausal atrophy of the
mucosa and urethral infection,
may also contribute.
In men, stress incontinence
may follow prostate surgery.
URGE INCONTINENCE
Detrusor contractions are Decreased cortical inhibition Involuntary urine loss preceded The small bladder is not
stronger than normal and of detrusor contractions from by an urge to void. The volume detectable on abdominal
overcome the normal stroke, brain tumor, dementia, tends to be moderate. examination.
urethral resistance. The and lesions of the spinal cord
bladder is typically small. above the sacral level. Urgency, frequency, and When cortical inhibition is
nocturia with small to decreased, mental deficits or
Hyperexcitability of sensory moderate volumes. motor signs of central nervous
pathways, as in bladder If acute inflammation is system disease are often
infections, tumors, and fecal present, pain on urination. present.
impaction
Possibly “pseudo-stress When sensory pathways are
Deconditioning of voiding incontinence”—voiding 10–20 hyperexcitable, signs of local
reflexes, as in frequent voluntary sec after stresses such as a pelvic problems or a fecal
voiding at low bladder volumes. change of position, going impaction may be present.
up- or downstairs, and possibly
coughing, laughing,
or sneezing.
Urinary Incontinence
PROBLEM MECHANISMS SYMPTOMS PHYSICAL SIGNS
OVERFLOW INCONTINENCE
Detrusor contractions are Obstruction of the bladder outlet, When intravesicular pressure Examination often reveals an
insufficient to overcome as in benign prostatic hyperplasia overcomes urethral resistance, enlarged, sometimes tender,
urethral resistance, causing or tumor. continuous dripping or dribbling bladder.
urinary retention. incontinence ensues.
Weakness of the detrusor muscle Other signs include prostatic
The bladder is typically associated with peripheral nerve Decreased force of the urinary enlargement, motor
flaccid and large, even after disease at S2–4 level. stream. signs of peripheral nerve
an effort to void. disease, a decrease in
Impaired bladder sensation that Prior symptoms of partial urinary sensation (including perineal
interrupts the reflex arc, as in obstruction or other symptoms sensation) and diminished to
diabetic neuropathy. of peripheral nerve disease absent reflexes.
may be present.
FUNCTIONAL INCONTINENCE
The patient is functionally Problems in mobility resulting from Incontinence on the way to The bladder is not detectable
unable to reach the toilet in weakness, arthritis, poor vision, or the toilet or only in the early on examination. Look for
time because of impaired other conditions. morning. physical or environmental
health or environmental clues as the likely cause.
conditions. Environmental factors such as an
unfamiliar setting, distant
bathroom facilities,
bed rails, or physical restraints.
INCONTINENCE SECONDARY TO MEDICATIONS
Drugs may contribute to any Sedatives, tranquilizers, Variable. A careful history Variable.
type of incontinence listed. anticholinergics, sympathetic and chart review are
blockers, and potent important.
diuretics.