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% of all patients experiencing urinary incontinence will have either urge incontinence/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 or bladder specificity. Bladder spasms can result from dietary factors (bladder stimulants-caffeine or alcohol), increased fluid intake, drug side effect, urinary tract infection/cancer, nerve dysfunction (associated with nerve trauma, diabetes, multiple sclerosis, or spinal cord injury). Primary treatment for overactive bladder is behavioral and medications, although recent procedures including neuromodulation and Botox have been used with success in refractory patients.
Stress Urinary Incontinence
Stress urinary incontinence (SUI) 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 which usually have a cumulative effect over the course of a woman's lifetime. Include vaginal childbirth, aging, menopause, obesity, chronic constipation, and smoking. As this is an anatomic condition, primary treatment is exercises and surgery although some vaginal devices have been used in select patients with success.
Mixed Incontinence
Mixed incontinence is a combination of OAB and SUI symptoms were the patient reports frequent urination and/or sensory urgency in conjunction with stress related symptoms. This may be due to a nerve related cause for both conditions or it may be a result of the patient voiding frequently in order to minimize the impact of her stress related urinary leakage with the bladder subsequently accommodating to a lower volume. 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 inability of the patient to sense a full bladder due to nerve damage-thus, resulting in inability to empty and frequent or constant dribbling of urine. 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 form any condition which would prevent the patient from getting to the toilet and thus wetting themselves. These include altered mental state or impaired mobility. Treatment may be a bedside commode or urinary catheterization.
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