Urinary incontinence (aka enuresis) is any leakage of urine. It is especially problematic if it occurs repeatedly, and in Pt's old enough expected to exercise such control.

• Urine is produced in the kidney and stored in the bladder
• Urination is the emptying of urine through the urethra, and is controlled by relaxation of the internal and external urethral sphincters, which are supported by the pelvic floor muscles
• When the bladder is full, stretch receptors send a signal to the brain. When it is not time to urinate, the brain returns an inhibitory signal to keep the urethral sphincters shut. When it is time to urinate, the inhibition is removed, and the detrusor muscle which empties the bladder contracts

Patient information

Before we get into urinary incontinence, how does normal urination exactly occur?
Urine is produced by the kidney. It's stored in the bladder. The storage usually doesn't "leak" because a set of muscles ("urethral sphincters" and "pelvic floor muscles" - keeps it from doing so. However, when storage is full, and you want to pee, the brain tells those muscles - "you can relax now". At the same time, another set of muscles ("detrusor muscles" contract to empty the bladder.

In adults:

• Mixed incontinence, which is a combination of urge and stress incontinence. It is not uncommon in elderly females, and can sometimes be complicated by urinary retention
  • Stress incontinence (see page)
  • Urge incontinence (see page)
• Overflow incontinence (see page)
• Functional incontinence (see page)

Patient information

I've heard of "stress" and "urgence" incontinence - in short, what's the difference ?
"Urge". That's just just as it sounds. You have overwhelming "urge" to pee. It's usually because you constantly need to go to the toilet. As compared with "stress". Again, that's just as it sounds. Whenever you face any "stress", you pee. That can be anything from coughing, jumping, bouncing ... well, anything . Without wanting to. That's more so to do with the fact that the muscles controlling having-to-pee, are weak.

"Mixed incontinence". I know in skateboarding, you have "combo" tricks like a 360 shove it+double heel flip. So is this like any "combo" of the urinary incontinences?
Not entirely. It involves only 2 of the most common ones. And we've chosen this "combo" because it's common in women. That is - the "stress". And "urgence" types.

I see. How about the other 2 types of incontinence? Overflow? And functional?
Overflow is like the opposite of urge incontinence. Whereas urge incontinence was too much contraction of the bladder-emptying muscles - usually caused by constant urges to pee. Overflow incontinence is too little contraction of the bladder. Causing retention of urine. Functional on the other hand, just means you simply can't be bothered going to the toilet. Or because of some medical condition, you can't get there.

Other classifications in adults:

• Transient incontinence, which is temporary incontinence. It can be triggered by medication, adrenal insufficiency, mental impairment, restricted mobility, stool impaction (severe constipation)
• Double incontinence, combining both urinary and fetal incontinence. Due to involvement of the same muscle group (levator ani) in bladder and bowel continence, Pt's are likely to have both → can be caused by damage from childbirth, complications from surgery especially involving the anal sphincters
• Post-void dribbling, where urine remains in the urethra after voiding the bladder, and slowly leaks out after urination → common and usually benign, but can indicate prostatitis, or post-prostate cancer surgery
• Coital incontinence, an urinary leakage that occurs during either penetration or orgasm, and can occur with a sexual partner or with masturbation → can be caused by pelvic floor disorders

In children:

• Bedwetting (see page)
• Daytime wetting (see page)

• HPC of voiding:
  • How often do you go to the toilet? → Urinary frequency
  • Do you have to pee at night? → Nocturia
  • When you have to go, do you have to go suddenly? → Urge incontinence
  • Or can you not make it because something is stopping you? → Functional incontinence
  • Do you ever leak urine? → Incontinence
  • Do you use pads? And if so, how often do you change them? → Polyuria/urge incontinence
  • Do you leak urine when you're giggling, laughing? → Stress incontinence
  • Do you ever feel like, when you go to the toilet, you can't empty your bladder? → Overflow incontinence
  • Do you have to strain when taking a pee? → Overflow incontinence
• Drug use → Diuretics/Urge incontinence
• Recent surgery? → Stress incontinence
• Physical exam:
  • Tumors blocking the urinary tract → Overflow incontinence
  • Stool impaction → Fecal incontinence
  • Poor reflexes or sensations → Neurological cause/Overflow incontinence

• Measurement of bladder capacity and post-void residual urine → inadequate bladder emptying/Overflow incontinence
• Stress test, where the Pt relaxes, then coughs vigorously as the Dr watches for loss of urine → Stress incontinence
• Urinalysis, for evidence of:
  • Bacterial infection → UTI → Urinary frequency/Urge incontinence
  • Urinary stones → Overflow incontinence
  • Glucose → DM → Polyuria/Urge incontinence
  • Other contributing causes
• Blood tests, examined for substances related to causes of incontinence
• U/S, to visualize the kidneys, ureters, bladder, and urethra → Overflow incontinence
• Urodynamic testing, which are techniques used to measure pressure in the bladder and the flow of urine → Overflow incontinence
• Cystoscopy, where a thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder
• Keep a bladder diary from 1 day-1 week, to record the pattern of voiding, noting times and amounts of urine produced

• Stress incontinence and urge incontinence are the most common types of urinary incontinence in women
• Stress incontinence is more common than urge incontinence
• Urinary incontinence affects 4% of the population, and 10% in those 65yo+
• Affects less as age progresses, including 33% of 5yo, 25% of 7yo, 15% of 9yo, 8% of 11yo, 4% of 13yo, 3% of 16yo
• Diurnal/day enuresis, is much less common [than noctural/night enuresis]
• In childhood, 60% are male, but this ratio increases such that by 11yo there are 2x as many boys [as girls]. In adulthood, women suffer from urinary incontinence 4x more than men
• Incidence is greater amongst those of lower socioeconomic status

• Urinary urgency
• Frequent urination
• Pelvic organ prolapse (cause of stress incontinence)
• Fecal incontinence