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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Adult and Senior Health Urinary Incontinence

Urinary Incontinence

Urinary incontinence means the bladder is unable to hold urine for as long as needed until it can be released voluntarily. Incontinence is not a disease in itself, but a symptom of some other problem


Urogenital Damage/dysfunction:

  • Aging
  • Estrogen deficiency
  • Neurological disease

  • Psychological disease


  • Urinary incontinence/prolapse is a natural part of aging
  • Nothing can be done about it

  • Surgery is the only solution

Urogenital Aging:

  • Urogenital aging is a symptom complex with associated physical findings

  • Involves the lower urinary and genital tracts and the pelvic floor


  • Frequency
  • Nocturia
  • Dysuria
  • Incomplete emptying
  • Incontinence
  • Urgency
  • Recurrent infections
  • Dyspareunia

  • Prolapse

Quality of Life Impact:

  • Impact on lifestyle and avoidance of activities
  • Fear of losing bladder control
  • Embarrassment
  • Impact on relationships
  • Increased dependence on caregivers

  • Discomfort and skin irritation

Types of Urinary Incontinence:

  • Genuine stress incontinence
  • Urge incontinence
  • Mixed
  • Chronic urinary retention and overflow incontinence
  • Functional incontinence
  • Miscellaneous (UTI, dementia)
  • Genuine stress incontinence
  • Urge incontinence
  • Mixed
  • Chronic urinary retention and overflow incontinence
  • Functional incontinence

  • Miscellaneous (UTI, dementia)

Genuine Stress Incontinence:

  • Loss of urine with increases in abdominal pressure
  • Caused by pelvic floor damage/weakness or weak sphincter(s)
  • Symptoms include loss of urine with cough, laugh, sneeze, running, lifting, walking

Urge Incontinence:

  • Loss of urine due to an involuntary bladder spasm (contraction)
  • Complaints of urgency, frequency, inability to reach the toilet in time, up a lot at night to use the toilet
  • Multiple triggers

Mixed Incontinence:

  • Combination of stress and urge incontinence
  • Common presentation of mixed symptoms
  • Urodynamics necessary to confirm

Chronic Urinary Retention:

  • Outlet obstruction or bladder under activity
  • May be related to previous surgery, aging, development of bad bladder habits, or neurologic disorders
  • Medication, such as antidepressants
  • May present with symptoms of stress or urge incontinence, continuous leakage, or urinary tract infection

Functional and Transient Incontinence:

  • Mostly in the elderly
  • Urinary tract infection
  • Restricted mobility
  • Severe constipation
  • Medication - diuretics, antipsychotics
  • Psychological/cognitive deficiency

Unusual Causes of Urinary Incontinence:

  • Urethral diverticulum
  • Genitourinary fistula
  • Congenital abnormalities (bladder extrophy, ectopic ureter)
  • Detrusor hyperreflexia with impaired contractility

Causes of Incontinence:

Inherited or genetic factors

  • Race
  • Anatomic differences
  • Connective tissue
  • Neurologic abnormalities

External factors:

  • Pregnancy and childbirth
  • Aging
  • Hormone effects
  • Nonobstetric pelvic trauma and radical surgery
  • Increased intra-abdominal pressure
  • Drug effects

Pregnancy and Childbirth:

  • Hormonal effects in pregnancy
  • Pressure of uterus and contents
  • Denervation (stretch or crush injury to pudendal nerve)
  • Connective tissue changes or injury (fascia)
  • Mechanical disruption of muscles and sphincters


  • Gravity
  • Neurologic changes with aging
  • Loss of estrogen
  • Changes in connective tissue cross linking and reduced elasticity

Hormone Effects:

  • Common embryonic origin of bladder urethra and vagina from urogenital sinus
  • High concentration of estrogen receptors in tissues of pelvic support
  • General collagen deficiency state in postmenopausal women due to the lack of estrogen (falconer et al., 1994)
  • Urethral coaptation affected by loss of estrogen

Increased Intra-abdominal Pressure:

  • Pulmonary disease
  • Constipation/straining
  • Lifting
  • Exercise
  • Ascites/hepatomegaly
  • Obesity

Drug Effects:

  • Alpha-blocking agents
  • Terazosin
  • Prazosin
  • Phenoxybenzamine
  • Phenothiazines
  • Methyldopa
  • Benzodiazepines

Fecal Incontinence:

  • Approximately 10% women with urinary incontinence have incontinence of flatus or stool



Conditions associated with overactive bladder

  • Hematuria
  • Pyuria
  • Glucosuria
  • Proteinuria
  • Urine culture

Post void Residual Volume (PVR):

  • If clinically indicated accurate PVR can be done by
  1.           Catheterization
  2.           Ultrasound
  • PVR of <50 ml is considered adequate, repetitive PVR >200 ml is considered inadequate
  • Use clinical judgment when interpreting PVR results in the intermediate range (50-199 ml)



  • Fluid management
  • Reduce caffeine, alcohol, and smoking
  • Bladder retraining
  • Pelvic floor exercises
  • Pessaries
  • Continence devices
  • Medication to help strengthen the urethra
  • Medication to help relax the bladder

Bladder retraining:

  • Regular voiding by the clock
  • Gradual increase in time between voids
  • Double voiding

Fluid management:

  • Avoid caffeine and alcohol
  • Avoid drinking a lot of fluids in the evening


  • Pelvic floor exercises
  • Vaginal cones
  • Devices for reinforcement

Pessaries :

  • Support devices to correct the prolapse
  • Pessaries to hold up the bladder

Hormone replacement:

  • Systemic  hormone replacement
  • Local hormone application
  • Vaginal cream
  • Vaginal estrogen ring

Medication to strengthen the urethra:

  • Cold medication  - Ornade

Medication to relax the bladder:

  • Oxybutynin (ditropan)
  • Toteridine (detrol)
  • Flavoxate (urispas)
  • Imipramine (elavil)


  • Burch repair
  • Marshall-marchetti-krantz repair
  • Sling
  • Needle suspension
  • Injections
  • Tension free vaginal tape