Urinary incontinence is defined as any uncontrolled loss of urine from the urethra. Continence depends on the functional integrity of the bladder and the urethral sphincter mechanism.
Up to 15% of women between the age of 30 and 40 are incontinent as are 25% of the women between the age of 40 and 50. Over 60% of women on geriatric wards have been reported to be incontinent.
Five forms of incontinence are distinguished:
- Imperative urinary urge incontinence: Urine loss with an uncontrollable urge to void, as with infections, bladder stones and rarely bladder tumors.
1.a. sensory urge: hypersensitive bladder, without bladder contractions
1.b. motor urge: with bladder contraction
- Reflex incontinence: Urine loss through uncontrollable bladder contraction without urgency, e.g. neurologic disorders.
- Stress incontinence: Insufficiency of the urethral sphincter mechanism. There are 3 degrees:
I Urine loss when coughing, sneezing, laughing;
II Urine loss with movement as when climbing stairs or lifting weights;
III Urine loss when lying as well as standing.
- Overflow incontinence: As consequence of a chronic lower urinary tract obstruction with stretching of the bladder musculature, as for example with benign prostatic hyperplasia.
- Extraurethral incontinence: Fistulas, as between the bladder and vagina.
Stress incontinence 40%, urge incontinence 20%, mixed forms 38%, other 2%.
- History: voiding habits, incontinence characteristics (when? where? why? how often?), previous surgery and medications
- Clinical examination including gynecological and neurological examination
- Depending on the findings of the clinical examination: urinary sediment, cystoscopy, x-ray and urodynamic (pressure measurements in the bladder) evaluation.
Treatment basicly depends on the form of incontinence.
a) Conservative: Exercises and rehabilitation of the pelvic floor. Changes in drinking habits, drug consumption, the use of pads, pessaries, catheters etc.
b) Surgical: Again the treatment depends on the etiology of the incontinence.
- Urge incontinence: treatment of the cause such as bladder stone removal
- Reflex incontinence: electrical neuromodulation of the nerve roots, bladder augmentation with a piece of small intestine
- Stress incontinence: collagen injection, abdominal bladder neck suspension (Marshall-Marchetti-Krantz, Burch) or vaginal bladder neck suspension, sphincter prosthesis
- Overflow incontinence: Treatment of the outflow obstruction, e.g. transurethral resection of the prostate
- Extraurethral incontinence: treatment of the fistula.