Urinary incontinence is defined as any involuntary leakage of urine. In addition to the urethra, urine may also leak from extraurethral sources, such as fistulas or congenital malformations of the lower urinary tract. Although incontinence is categorized into a number of forms, this chapter will focus on the evaluation and management of stress and urge urinary incontinence. Stress urinary incontinence (SUI) is the involuntary leakage of urine with exertion or with sneezing or coughing. Urge urinary or “urge”—incontinence is the involuntary leakage accompanied or immediately preceded by a perceived strong imminent need to void. A related condition, overactive bladder, describes urinary urgency with or without incontinence and usually with increased daytime urinary frequency and nocturia (Abrams, 2009).
According to International Continence Society guidelines, urinary incontinence is a symptom, a sign, and a condition (Abrams, 2002). For example, with SUI, a patient may complain of involuntary urine leakage with exercise or laughing. Concurrent with these symptoms, involuntary leakage from the urethra synchronous with cough or Valsalva may be observed during examination by a provider. And as a condition, SUI is objectively demonstrated during urodynamic testing if involuntary leakage of urine is seen with increased abdominal pressure and absence of detrusor muscle contraction. Under these circumstances, when the symptom or sign of SUI is confirmed with objective testing, the term urodynamic stress incontinence (USI), formerly known as genuine stress incontinence, is used.
With urge urinary incontinence, women have difficulty postponing urination urges and generally must promptly empty their bladder on cue and without delay. If urge urinary incontinence is objectively demonstrated during urodynamic testing with cystometric evaluation, the condition is termed detrusor overactivity (DO), formerly known as detrusor instability. When both stress and urgency components are present, it is called mixed urinary incontinence.
Functional incontinence occurs in situations in which a woman cannot reach a toilet in time because of physical, psychological, or mentation limitations. Often, this group would be continent if these issues were absent.
In Western societies, epidemiologic studies indicate a prevalence of urinary incontinence of 15 to 55 percent. This wide range is attributed to variations in research methodologies, population characteristics, and definitions of incontinence. As part of the 2005-2006 National Health and Nutrition Examination Survey (NHANES), a cross-sectional group of 1961 nonpregnant, noninstitutionalized women in the United States were questioned about pelvic floor disorders. Urinary incontinence that was characterized by participants as moderate to severe leakage was identified in 15.7 percent (Nygaard, 2008). However, current available data are limited by the fact that most women do not seek medical attention for this condition (Hunskaar, 2000). It is estimated that only one in four women will seek medical advice for incontinence due to embarrassment, limited access to health care, or poor screening by health care providers (Hagstad, 1985).
Among ambulatory women with urinary incontinence, the most common ...