Urinary Incontinence
04/15/2022 Haweni A. 1
Definition
• Involuntary loss of urine or stool in sufficient
amount or frequency to constitute a social
and/or health problem.
• A heterogeneous condition that ranges in
severity from dribbling small amounts of urine
to continuous urinary incontinence with
concomitant fecal incontinence.
04/15/2022 Haweni A. 2
Urinary Incontinence
• Is a leakage of urine which is associated with
hygienic or social problems and can be
demonstrated objectively.
• Types of urinary incontinence
oUrge incontinence(motor or sensory)
oGenuine Stress incontinence
oOverflow incontinence
oBypass (true )incontinence
04/15/2022 Haweni A. 3
• Urinary incontinence may be to any of the
following, alone or in combination
o Lower urethral pressure
o Detrusor contraction
o Greater transmission of IAP to the bladder than
vesicourethral junction.
o Passive increase in intravesical pressure due to
distention beyond the elastic units of bladder
o by passing the continence mechanism
04/15/2022 Haweni A. 4
• When the urinary tact is intact, continence is
maintained as long as the pressure closing
the urethra is greater than the intravesical
pressure .
• When the pressure gradient is reversed,
urine passes the urethra and involuntary
micturation due to relaxation and detrusor
muscle contraction
04/15/2022 Haweni A. 5
Tests and investigations
• Urinary stress test
• Pad test
• Cotton -tipped applicator(Q-tip) test
• Dye (cotton ball ) test
• U/A, urine culture,
cystoscopy/urthroscopy/
04/15/2022 Haweni A. 6
Genuine stress incontinence
• Is involuntary loss of urine through urethra
occurring simultaneously with an increase in
IAP but in the absence of detrusor muscle
contraction.
• Normally, at rest IUP>IVP. But in stressful
activities (coughing, exercise) the resting IVP
> IUP then the urethral closure pressure will
decrease to zero, and GSI will be resulted
04/15/2022 Haweni A. 7
Causes
• Anatomic descent of the proximal urethra
below its normal intraabdominal position
during stressful activities
• Dysfunctions of the extrinsic or intrinsic
urethral sphincter.
• Failure of neuromuscular mechanisms
that increases IAP
04/15/2022 Haweni A. 8
Clinical features
• The classic symptom is involuntary loss of urine w/c occur
simultaneously with stressful activities (laughing, sneezing
or coughing)
• Involuntary loss of urine stops as soon as the stressful act is
over
• Dx criteria to dx GSI are
• Normal neurologic findings
• Poor anatomic support(Q-tip test, X-ray or urethroscopy)
• Demonstrable leakage with stress(pad test)
• Normal U/A, negative urine culture
04/15/2022 Haweni A. 9
Mgt
• Poor anatomic support(kegil exercise,
estrogen for elder women )
• For intrinsic sphincter defect alpha
adrenergic agonists
• Surgical either vaginally or abdominally
04/15/2022 Haweni A. 10
Urge incontinence
• Detrusor instability results involuntary
leakage
• May be associated with cystitis
• In unstable bladder, uninhibited detrusor
contractions either spontaneously or upon
provocation
04/15/2022 Haweni A. 11
Clinical feature
• Pts have strong urge for urination moments
before incontinence
• Associated with stressful activities, incontinence
continues during and after stressful activates
over
• Symptom of UTI may be present
• Physical examination may be normal
• Neurologic signs typically absent
• Anatomic support may be good or poor
04/15/2022 Haweni A. 12
Dx
• Delayed urinary leakage or Continuous heavy
flow despite the pt’s effort to stop during
urinary test.
• Urethercystometry confirms the dx
04/15/2022 Haweni A. 13
Mgt
• Medications
• Anticholinergic agents are the most effective
• Calcium channel blockers and prostaglandin synthesis
inhibitors
• Behavioral modification ;bladder retaining and
psychotherapy
• Surgery is the least resort of mgt
• Denervation
• Cystoplasty
• Urinary diversion
04/15/2022 Haweni A. 14
Sensory urge incontinence
It is leakage of urine (in association with great
urgency) that occurs in a stable bladder without
excessive descent of urethra or bladder
• Associated with bladder irritation secondary to
cystitis, bladder stone or neoplasia
• The pt has the ability to inhibit detrusor contraction
• Psychological factors may stimulate the afferent arc
of micturation and results strong urge to
incontinence
04/15/2022 Haweni A. 15
C/F
• Incontinence is associated with frequency,
urgency, dysuria and or hematuria
Dx. U/A shows UTI , urethroscopy &cystoscopy
• Usually Normal cystometric findings
Mgt –Rx of infection and underlying causes
04/15/2022 Haweni A. 16
Overflow incontinence
• When the patient's bladder is always full so that
frequent leakage of urine occur. a blocked urethra
can cause this type of incontinence.
• Pathophysiology;
• Autonomic neuropathy (from Dm or multiple
sclerosis) can decrease neural signals from the
bladder (allowing for overfilling) and may also
decrease the expulsion of urine by the detrusor
muscle (allowing for urinary retention).
04/15/2022 Haweni A. 17
otumors and kidney stone can block the
urethra.
o Spinal cord injuries or nervous system
disorders are additional causes of
overflow incontinence
oPelvic mass( advanced UVP) ,
Anticholinergic drug may worsen overflow
incontinence
04/15/2022 Haweni A. 18
Treatment
• Treating the underlying causes
• Medical mgt that directs towards reducing urethral closure
pressure and increasing detrusor contractility
Eg. Bethanechol
• Catheterization
• If an incontinence is due to overflow incontinence, in
which the bladder never empties completely, or if the
bladder cannot empty because of poor muscle tone, a
catheter may be used to empty the bladder.
04/15/2022 Haweni A. 19
Bypass incontinence
• Urinary leakage occurs as a result of bypassing the
normal anatomic urethral continence mechanism.
• Characterized by continuous leakage of urine
uncontrollably.
• Causes
• Genito urinary fistula-commonest
• Diverticulum
• Ectopic ureter
• Rx
• Surgical correction (diverticulum,fistula)
04/15/2022 Haweni A. 20
Reading Assignment
• Read on the
• Definition
• Risk factors
• Etiology
• Diagnosis
• Management
• Of obstetrics fistula
04/15/2022 Haweni A. 21