Ambo University

College of Health Sciences and Referral Hospital

Department of Midwifery

Urinary Incontinence
By: Temesgen D (MSc/MRH)

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 Learning objectives
• At the end of this class the students will be able to:
• Define the urinary incontinence
• Describe the causes of unitary incontinence
• Diagnose urinary incontinence
• Manage urinary incontinence
• Discuss preventive methods of urinary incontinence

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 Urinary incontinence
 Definition: Urinary incontinence is defined as involuntary loss

of urine that is objectively demonstrable and is a social or

hygienic problem

 It is a medical condition affecting 15% to 50% of adult women

depending on the age and risk factors of the population studied.

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Innervation of Lower urinary tract
• The lower urinary tract is under the control of both parasympathetic
and sympathetic nerves.

• The parasympathetic fibers originate in the sacral spinal cord

segments S2 through S4.

• Stimulation of the pelvic parasympathetic nerves and administration of

cholinergic drugs cause the detrusor muscle to contract.

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 Nervous Supply of bladder
The sympathetic nervous system

• Hypogastric nerve (T12 – L2).

• It causes relaxation of the detrusor muscle.

• These functions promote urine retention.

• Contracting the internal sphincter at the bladder neck

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 Nervous Supply of bladder
The parasympathetic nervous system
• Pelvic nerve(S2-S4).

• Increased signals from this nerve causes contraction of the detrusor muscle.

• This stimulates micturition.

• Relaxing the internal sphincter at the bladder neck

o The somatic nervous supply gives us voluntary control over micturition.

o It innervates the external urethral sphincter, via the pudendal nerve (S2-S4).

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 Epidemiology of UI
• Increases with age.

• Approximately 25% to 45% of women and 10% to 30% of

men experience

• More common in women than in men.

• Female to male ratio may range from 2:1 to 4:1

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Types of UI
1) Stress incontinence

2) Urge incontinence

3) Mixed incontinence

4) Overflow incontinence

5) Total incontinence

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1. Stress incontinence
Involuntary loss of urine through an intact urethra as a result
of sneezing, coughing, or changing position
It predominantly affects women who have had vaginal
deliveries
Is thought to be the result of decreasing ligament.

Pelvic floor support of the urethra and decreasing or absent

estrogen levels within the urethral walls and bladder base.

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Grades of stress incontinence
Grade I
• Incontinence occurs only with severe stress, such as coughing, sneezing, etc

Grade II
• Incontinence with moderate stress, such as rapid movement or walking up and
down stairs

Grade III
• Incontinence with mild stress, such as standing.

• The patient is continent in the supine position

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 Risk factors of Stress UI
1. Congenital weakness of the internal urethral sphincter, seen in the young nullipara.

2. Congenital defects as:

 Short urethra (less than 1 cm),
 Wide bladder neck, and
 Separation of symphysis pubis.

3. Genital prolapse:

 Bladder neck descends below the level of the pelvic floor,

4. Trauma to the region of the bladder neck due to vaginal delivery or operation

5. Menopause: Lack of oestrogen leads to atrophy of bladder neck supports.

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 2. Urge incontinence
• Involuntary loss of urine associated with a sudden and strong urge to
void that cannot be suppressed.

• Also known as overactive bladder

• The patient is aware of the need to void but is unable to reach a toilet
in time.

• People with urge incontinence may experience frequent urination

• It occurs due to an overactive detrusor muscle.

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 3. Mixed incontinence

Is combination of stress and urge incontinence

Experienced symptoms of both types, including leakage with

activities that increase abdominal pressure and sudden urges to

urinate

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 4. Total Incontinence- Urinary Fistula

• Severe form of urinary incontinence

• It is a complete and continuous inability to control the leakage of urine

• It is characterized by the constant and involuntary loss of urine, without

any ability to voluntarily hold or control urination.

• They usually result from operative deliveries (e.g., forceps) rather than

from neglected labor and pressure necrosis.

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5. Overflow Incontinence

• Overflow incontinence occurs when the bladder does not empty

properly, resulting in a constant or frequent dribbling of urine.

• It is often caused by an obstruction or impaired bladder muscle

contraction, leading to incomplete bladder emptying.

• Individuals with overflow incontinence may have a weak urine stream

and may need to strain to initiate urination.

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Diagnosis
A. History
• A detailed history differentiates between the different types of
incontinence.
• Gradual onset after menopause suggests estrogen deficiency.
• History of vaginal repair or operation in the region of the bladder
neck and history of any neurologic disease.

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Diagnosis
History
• A detailed history differentiates between the different types of incontinence.
• Gradual onset after menopause suggests estrogen deficiency.
• History of vaginal repair or operation in the region of the bladder neck and history
of any neurologic disease.
Assessment
• Extensive urodynamic tests may be performed.
• Urinalysis and urine culture are performed to identify infection
• Urinary incontinence may be transient or reversible if the underlying cause is successfully
treated and the voiding pattern reverts to normal
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 Management of urinary incontinence

• The management of urinary incontinence depends on:

• The underlying cause,

• Type of incontinence,

• Severity of symptoms and

• The individual's overall health

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 Management of UI: Lifestyle Modifications
• Bladder Training: This involves scheduled voiding

• Fluid Management: adjusting fluid intake, especially reducing or

avoiding bladder irritants like caffeine and alcohol, can help manage
urinary symptoms.

• Healthy Weight Maintenance: maintaining a healthy weight can reduce

pressure on the bladder and pelvic floor muscle

• Pelvic Floor Muscle Exercises: also known as Kegel exercises, these

exercises help strengthen the muscles that control urination.
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 Management of UI: Behavioral Techniques
• Double Voiding: After emptying the bladder, waiting a few minutes and

then making another attempt to ensure the bladder is adequately emptied.

• Timed Voiding: Setting a schedule for regular toilet visits, even if there

is no urge to urinate.

To prevent accidents and promote better bladder control.

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 Management of UI: Medications
• Anticholinergic Medications: helps relax an overactive bladder and

reduce the frequency and urgency of urination. eg. Oxybutynine

• Topical Estrogen: will provide for postmenopausal women for

improving the strength and elasticity of the tissues in the urethra and

vaginal area which can help with stress incontinence.

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 Management of UI: Medical Devices and Interventions

• Pessaries: inserted into the vagina to support the bladder and help control stress

incontinence.

• Catheterization: For individuals with urinary retention or overflow

incontinence, intermittent or indwelling catheters may be used to empty the

bladder.

• Surgical Interventions: In certain cases, surgical procedures such as sling

procedures, bladder neck suspension, or artificial urinary sphincter implantation

may be recommended to treat specific types of incontinence.

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 Thank You!!!

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