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Urinary incontinence

The plus side of incontinence? Calvin Klein absorbent pull ups!

Definition

Involuntary leakage of urine.

Epidemiology

Common.jpg
Very common, especially in women, and the elderly.

Pathophysiology

There are 5 main types:

  • Stress incontinence - happens on coughing, or lifting, or other things that cause physical stress. Common in women post birth or hysterectomy, and in men after a prostatectomy.
  • Urge incontinence - overactive detrusor muscle in the bladder causes a sudden feeling of "I need to go", accompanied with a bit of wee.
  • Overflow incontinence - the bladder is always full, so there's a constant dribble of wee "overflowing". Usually caused by blockage to outflow, rare in women, common with benign prostatic hypertrophy in men. Can also be cuased by neuropathy, from diabetes or MS.
  • Functional incontinence - patient is too disabled to get to the loo on time. They know they need to wee, but can't get out of the chair and down the corridor fast enough. Common in old people.
  • Noctural enuresis (bedwetting) - this is normal in children.

Differential Diagnosis

  • Prostatic hypertrophy - This is the commonest cause, seen in elderly men, and it causes overflow incontinence.
  • Stress incontinence - Pretty common, seen in anyone post surgery - see above for common operations.
  • Overactive detrusor - The cause of all urge incontinence. Treated with botox, injected into the bladder.
  • Urinary tract infection - UTI can cause incontinence, especially in the elderly.
  • Neurological - In younger patients, diseases such as Multiple sclerosis and spinal injuries cause this. In the elderly, very common in later stages of dementia and in general delirium.