Types of Incontinence and Risk Factors

There are various types of urinary incontinence and it is important for the patient to undergo appropriate diagnosis as the treatment of each incontinence type varies significantly. Approximately 90 percent of all patients experiencing urinary incontinence will have either urge incontinence overactive bladder (OAB), stress incontinence, or mixed incontinence. A small minority may have rarer forms of incontinence including overflow incontinence, anatomic incontinence, or functional incontinence. It is important that the correct diagnosis be made prior to initiating an appropriate treatment plan.

Overactive Bladder

Previously known as urge incontinence, overactive bladder is a condition characterized by frequent urination during day or night, sudden urge to urinate, and/or bedwetting with or without urinary leakage. Typically, patients complain of a sudden urge to urinate, sometimes not being able to make it to the bathroom with associated leakage. This condition is due to spontaneous bladder spasms and has also been described as detrusor instability. Bladder spasms can result from dietary factors (bladder stimulants-caffeine or alcohol), increased fluid intake, drug side effects, urinary tract infection/cancer, nerve dysfunction (associated with nerve trauma, diabetes, multiple sclerosis, or spinal cord injury). Primary treatments for overactive bladder include behavioral interventions and medications.

Stress Urinary Incontinence

Stress urinary incontinence is one of the most common types of incontinence and is characterized by urinary leakage during activity including coughing, sneezing, exercising, lifting, and laughing. As the condition progresses, it can become severe enough to happen with simple acts including bending and walking. This condition is due to an anatomic weakness of the bladder neck which typically maintains the seal of urine during activity. SUI can result from a variety of conditions including vaginal childbirth, aging, menopause and obesity. As this is an anatomic condition, primary treatment may involve pelvic floor exercises and/or minimally invasive surgery.

Mixed Incontinence

Mixed incontinence is a combination of OAB and SUI symptoms in which the patient reports frequent urination and/or sensory urgency in conjunction with stress related symptoms. This may be due to a nerve related cause or it may be due to the patient voiding frequently to avoid leaking. Typically, it is important to determine which component, OAB or SUI, is most bothersome and then treat that initially. Treatment options include a combination of medications, exercises, and surgery based on appropriate diagnosis.

Other Types of Incontinence

Other types of incontinence are relatively uncommon but should be considered as part of the differential diagnosis especially in patients that have not improved with traditional therapies. Overflow incontinence occurs due to the inability of the patient to sense a full bladder.  Risk factors include bladder injury, radical pelvic surgery, spinal cord or neurologic injury, or the use of certain drugs. Treatment includes physical therapy, neuromodulation, and urinary catheterization.

• Anatomic incontinence typically occurs early in life or after surgical intervention and is due to abnormal anatomy resulting in urinary leakage. These conditions include ectopic ureter, urethral diverticulum, and urinary fistula. Treatment is typically surgery.
• Functional incontinence results from any condition – including altered mental state or impaired mobility – which prevents the patient from getting to the bathroom in time. Treatment may be a bedside commode or urinary catheterization.