Author:

Editor(s):

Updated:

ULY CLINIC

19 Septemba 2025, 04:51:48

Urinary incontinence

Urinary incontinence is the involuntary passage of urine resulting from bladder abnormalities, neurologic disorders, or pelvic muscle weakness. It may be transient or permanent, involving large volumes or scant dribbling. Incontinence is classified as:

Stress incontinence: Leakage during sudden physical strain (cough, sneeze, laugh, quick movement).
Overflow incontinence: Dribbling due to urine retention from bladder overdistention.
Urge incontinence: Sudden, uncontrollable urge to urinate.
Total incontinence: Continuous leakage due to bladder inability to retain urine.

Pathophysiology

Bladder dysfunction: Reduced detrusor contractility or bladder overactivity leads to incomplete emptying or involuntary contractions.
Neurologic disorders: Stroke, spinal cord injury, or multiple sclerosis impair the central or peripheral control of micturition.
Pelvic muscle weakness: Damage to pelvic floor muscles (e.g., post-childbirth, aging) reduces urethral support and sphincter tone.
Obstruction: Prostatic enlargement, urethral stricture, or tumors can impede urine flow, causing overflow incontinence.
Surgery or trauma: Damage to urethral sphincters during prostatectomy or pelvic surgery may result in permanent incontinence.

History and Physical Examination

History

Onset: sudden vs gradual.
Pattern: daytime/nighttime, partial or total incontinence.
Volume of urine lost, fluid intake, coping strategies.
Associated urinary symptoms: hesitancy, frequency, urgency, nocturia, weak stream.
Medical history: UTIs, prostate disease, spinal injury, stroke, pelvic surgery.
Women: number of pregnancies and childbirths.

Physical Examination

Observe for urine leakage after bladder emptying; female patients may be asked to bear down.
Inspect urethral meatus for inflammation or anatomic defect.
Palpate bladder for distention.
Conduct a neurologic assessment: motor and sensory function, muscle atrophy.

Medical causes

Cause	Onset	Key Features	Associated Findings	Pathophysiology	Management
BPH (Benign Prostatic Hyperplasia)	Gradual	Overflow incontinence	Weak stream, incomplete voiding, nocturia, hematuria	Urethral obstruction → urine retention	Medical management, surgery if severe
Bladder cancer	Gradual	Urge incontinence, hematuria	Frequency, dysuria, nocturia, dribbling, suprapubic pain	Tumor obstructs bladder or irritates mucosa	Surgery, chemo/radiation as indicated
Diabetic neuropathy	Gradual	Overflow incontinence	Painless bladder distention, nocturnal diarrhea/constipation, impotence	Autonomic neuropathy → impaired bladder emptying	Optimize glycemic control, intermittent catheterization
Multiple sclerosis (MS)	Gradual	Urgency, frequency, incontinence	Visual problems, spasticity, hyperreflexia, ataxia	CNS demyelination → bladder dysregulation	Bladder training, medications, catheterization
Prostate cancer (advanced)	Late	Urinary incontinence	Hesitancy, frequency, nocturia, dysuria, perineal pain, hard nodular prostate	Obstruction from tumor	Oncologic treatment, supportive care
Chronic prostatitis	Gradual	Incontinence	Frequency, urgency, dysuria, hematuria, perineal pain, ejaculatory pain	Chronic inflammation, urethral obstruction	Antibiotics, alpha-blockers, supportive therapy
Spinal cord injury	Acute	Overflow incontinence	Flaccid bladder, paraplegia, sensory loss, muscle atrophy	Disruption of sacral micturition pathways	Catheterization, bladder training, surgery if needed
Stroke	Acute or chronic	Transient or permanent incontinence	Contralateral hemiplegia, aphasia, dysarthria, cognitive changes	Impaired central bladder control	Bladder training, rehabilitation
Urethral stricture	Gradual	Overflow incontinence	Decreased urine stream, urinomas, urosepsis	Mechanical obstruction	Dilation, urethroplasty
UTI	Acute	Incontinence with urgency, frequency	Dysuria, hematuria, cloudy urine, urethral discharge (males)	Bladder irritation and inflammation	Antibiotics, hydration

Other causes

Surgery: Post-prostatectomy incontinence due to sphincter damage.

Emergency interventions

Acute urinary retention: Insert a catheter to relieve bladder distention.
Neurologic impairment with retention: Monitor for overflow incontinence; intermittent catheterization may be required.

Special considerations

Monitor voiding pattern and bladder distention.
Implement bladder retraining program for controllable incontinence.
Assess for underlying causes: structural, neurologic, infectious.

Bladder retraining guidelines

Assess baseline fluid and voiding patterns.
Encourage timed voiding 30 min before expected incontinence.
Gradually increase interval between voids to 3–4 hours.
Maintain consistent stimuli sequence.
Ensure privacy and avoid inhibiting stimuli.
Keep a 5-day record of continence/incontinence.

Tips for Success:

Easy access to toilet; clear path at night.
Assistance for mobility if needed.
Encourage regular clothing; use pads or male condoms if necessary.
Maintain hydration (2–2.5 L/day), limit evening fluids.
Reassure patient lapses do not indicate program failure.

Patient counseling

Educate about Kegel exercises and self-catheterization.
Discuss medications affecting bladder control.
Encourage persistent effort with bladder retraining.
Address psychosocial impact: embarrassment, frustration, and coping strategies.

Pediatric pointers

Causes: incomplete voiding, ectopic ureter, UTIs.
Evaluate for congenital anomalies if persistent.

Geriatric pointers

UTIs may present as incontinence or altered mental status.
Elderly may develop incontinence due to reduced bladder control.
Consider neurologic, vascular, or obstructive causes in older adults.

References

Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis, MO: Mosby Elsevier; 2008:444–447.
Colyar MR. Well-Child Assessment for Primary Care Providers. Philadelphia, PA: F.A. Davis; 2003.
Schuiling KD. Women’s Gynecologic Health. Burlington, MA: Jones & Bartlett Learning; 2013.
Sommers MS, Brunner LS. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.
Abrams P, Cardozo L, Wagg A, Wein A. Incontinence: 6th International Consultation on Incontinence. Bristol: ICUD-EAU; 2017.
Norton P, Brubaker L. Urinary incontinence in women. Lancet. 2006;367:57–67.
Herschorn S. Overview of adult urinary incontinence. Can J Urol. 2010;17 Suppl 1:1–6.
Wein AJ, Kavoussi LR, Partin AW, Peters CA. Campbell-Walsh Urology. 12th ed. Philadelphia, PA: Elsevier; 2020.