ABC of Urology: URINARY INCONTINENCE AND URINARY INFECTION

doi:10.1136/bmj.312.7036.961

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Chris Dawson,
Hugh Whitfield

Urinary incontinence

Urinary incontinence is a common reason for referral to a urologist, but the exact prevalence in the community is unknown as many patients conceal their symptoms because of embarrassment.

Types of incontinence

Stress incontinence
Urge incontinence
Continuous incontinence

Stress incontinence

Stress incontinence describes leakage of urine in response to any physical activity that raises intra-abdominal pressure, such as coughing, sneezing, bending down, and any exercise. It occurs most often in women but is also seen in men after transurethral resection of the prostate (after damage to the external urethral sphincter). About 50% of all women aged over 18 years will have mild stress incontinence. Stress incontinence in women commonly develops after childbirth and is thought to be due to a pressure denervation of the pelvic floor. Obesity may worsen the symptoms—dieting may bring about an improvement, although patients who are incapacitated by incontinence often find it difficult to lose weight.

Urge incontinence

Urge incontinence is leakage of urine preceded by an urgent desire to pass urine
Usually the patient is incontinent before reaching the toilet
Urge incontinence is more common in women—usually the result of idiopathic instability of the bladder
The condition can occur de novo in men but is seen more often in the presence of outflow obstruction of the bladder
Recent studies suggest that obstruction leads to neural degeneration and connective tissue deposition in the bladder wall and hypersensitivity to local neurotransmitters
Urge incontinence may occur after spinal trauma or other spinal cord disorders that lead to the development of a neuropathic bladder

Continuous incontinence

Continuous incontinence in men usually implies chronic urinary retention with overflow, which develops insidiously with outflow tract obstruction from any cause. Continual leakage of urine in women is usually due to fistulas involving the urinary bladder, and vesicovaginal fistula is particularly common after hysterectomy.

Continuous incontinence is the continual leakage of urine …