Stress incontinence: childbirth/surgery/radiation/oestrogen deficit → denervation/atrophy of pelvic floor → involuntary leakage of urine during increased intra-abdominal pressure (in the absence of a detrusor contraction).
Urge incontinence: (aka overactive bladder syndrome) idiopathic/neuro/surgery → detrusor overactivity → urgency, frequency and nocturia, in the absence of urinary tract infection or any other obvious pathology.
Other Causes
Overflow incontinence – leakage of urine from an overfull urinary bladder, often in the absence of any urge to urinate.
Bladder fistulae – opening between the bladder and another organ (e.g. the vagina or rectum).
Urethral diverticulum – out-pocketing of the urethra into the anterior vaginal wall.
Congenital anomalies – e.g. ectopic ureter.
Functional incontinence – physical or mental barriers that prevent the patient reaching the toilet (e.g immobility, dementia).
Temporary incontinence – due to reversible factors such as constipation and urinary tract infection.
Risk factors
pregnant
older women
VD
comorbidities
high impact exercise
Clinical Features
Stress Incontinence:
involuntary leakage of urine on exertion (coughing, sneezing or exercise).
small volume coinciding with physical stress
On examination, prolapse of the urethra and anterior vaginal wall may be present.
Also, asking the woman to cough with a semi-full bladder may demonstrate the incontinence.
Urge Incontinence
urgently needing to pass urine, resulting in involuntary leakage.
urgency, frequency and nocturia.
often trigger factors such as hearing running water, cold weather, etc.
typically large volumes of leakage compared to stress incontinence.
Bladder contractions may be triggered by coughing or sneezing which can lead to the false assumption that stress incontinence is present.