urinary incontinence urinary incontinence urinary incontinence (ui), also known as involuntary urination, is any uncontrolled leakage of urine. it is a common and distressing problem, which may have a large impact on quality of life. it has been identified as an important issue in geriatric health care. the term enuresis is often used to refer to urinary incontinence primarily in children, such as nocturnal enuresis (bed wetting). ui is an example of a stigmatized medical condition, which creates barriers to successful management and makes the problem worse. people may be too embarrassed to seek medical help, and attempt to self-manage the symptom in secrecy from others. urinary incontinenceother namesinvoluntary urinationanatomy of the lower urinary tract and genital system. the top diagram shows the female urinary system, and the bottom shows the male urinary system.specialtyurology, gynecology pelvic surgery, pregnancy, childbirth, and menopause are major risk factors. urinary incontinence is often a result of an underlying medical condition but is under-reported to medical practitioners. there are four main types of incontinence: urge incontinence due to an overactive bladder stress incontinence due to "a poorly functioning urethral sphincter muscle (intrinsic sphincter deficiency) or to hypermobility of the bladder neck or urethra" overflow incontinence due to either poor bladder contraction or blockage of the urethra mixed incontinence involving features of different other types treatments include pelvic floor muscle training, bladder training, surgery, and electrical stimulation. behavioral therapy generally works better than medication for stress and urge incontinence. the benefit of medications is small and long term safety is unclear. urinary incontinence is more common in older women. causes urinary incontinence can result from both urologic and non-urologic causes. urologic causes can be classified as either bladder dysfunction or urethral sphincter incompetence and may include detrusor overactivity, poor bladder compliance, urethral hypermobility, or intrinsic sphincter deficiency. non-urologic causes may include infection, medication or drugs, psychological factors, polyuria, hydrocephalus, stool impaction, and restricted mobility. the causes leading to urinary incontinence are usually specific to each sex, however, some causes are common to both men and women. women pelvic floor muscles in women the most common types of urinary incontinence in women are stress urinary incontinence and urge urinary incontinence. women that have symptoms of both types are said to have "mixed" urinary incontinence. after menopause, estrogen production decreases and, in some women, urethral tissue will demonstrate atrophy, becoming weaker and thinner, possibly playing a role in the development of urinary incontinence. stress urinary incontinence in women is most commonly caused by loss of support of the urethra, which is usually a consequence of damage to pelvic support structures as a result of pregnancy, childbirth, obesity, age, among others. about 33% of all women experience urinary incontinence after giving birth, and women who deliver vaginally are about twice as likely to have urinary incontinence as women who give birth via a caesarean section. stress incontinence is characterized by leaking of small amounts of urine with activities that increase abdominal pressure such as coughing, sneezing, laughing and lifting. this happens when the urethral sphincter cannot close completely due to the damage in the sphincter itself, or the surrounding tissue. additionally, frequent exercise in high-impact activities can cause athletic incontinence to develop. urge urinary incontinence, is caused by uninhibited contractions of the detrusor muscle, a condition known as overactive bladder syndrome. it is characterized by leaking of large amounts of urine in association with insufficient warning to get to the bathroom in time. men the prostate with the urethra passing through it (prostatic urethra) urge incontinence is the most common type of incontinence in men. similar to women, urine leakage happens following a very intense feeling of urination, not allowing enough time to reach the bathroom, a condition called overactive bladder syndrome. in men, the condition is commonly associated with benign prostatic hyperplasia (an enlarged prostate), which causes bladder outlet obstruction, a dysfunction of the detrusor muscle (muscle of the bladder), eventually causing overactive bladder syndrome, and the associated incontinence. stress urinary incontinence is the other common type of incontinence in men, and it most commonly happens after prostate surgery. prostatectomy, transurethral resection of the prostate, prostate brachytherapy, and radiotherapy can all damage the urethral sphincter and surrounding tissue, causing it to be incompetent. an incompetent urethral sphincter cannot prevent the urine from leaking out of the urinary bladder during activities that increase the intraabdominal pressure, such as coughing, sneezing, or laughing. continence usually improves within 6 to 12 months after prostate surgery without any specific interventions, and only 5 to 10% of people report persistent symptoms. both age is a risk factor that increases both the severity and prevalence of ui polyuria (excessive urine production) of which, in turn, the most frequent causes are: uncontrolled diabetes mellitus, primary polydipsia (excessive fluid drinking), central diabetes insipidus and nephrogenic diabetes insipidus. polyuria generally causes urinary urgency and frequency, but does not necessarily lead to incontinence. neurogenic disorders like multiple sclerosis, spina bifida, parkinson's disease, strokes and spinal cord injury can all interfere with nerve function of the bladder. this can lead to neurogenic bladder dysfunction overactive bladder syndrome. however, the etiology behind this is usually different between men and women, as mentioned above. other suggested risk factors include smoking, caffeine intake and depression mechanism adults the body stores urine — water and wastes removed by the kidneys — in the urinary bladder, a balloon-like organ. the bladder connects to the urethra, the tube through which urine leaves the body. continence and micturition involve a balance between urethral closure and detrusor muscle activity (the muscle of the bladder). during urination, detrusor muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. at the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. the urethral sphincter is the muscular ring that closes the outlet of the urinary bladder preventing urine to pass outside the body. urethral pressure normally exceeds bladder pressure, resulting in urine remaining in the bladder, and maintaining continence. the urethra is supported by pelvic floor muscles and tissue, allowing it to close firmly. any damage to this balance between the detrusor muscle, urethral sphincter, supportive tissue and nerves can lead to some type of incontinence . for example, stress urinary incontinence is usually a result of the incompetent closure of the urethral sphincter. this can be caused by damage to the sphincter itself, the muscles that support it, or nerves that supply it. in men, the damage usually happens after prostate surgery or radiation, and in women, it's usually caused by childbirth and pregnancy. the pressure inside the abdomen (from coughing and sneezing) is normally transmitted to both urethra and bladder equally, leaving the pressure difference unchanged, resulting in continence. when the sphincter is incompetent, this increase in pressure will push the urine against it, leading to incontinence. another example is urge incontinence. this incontinence is associated with sudden forceful contractions of the detrusor muscle (bladder muscle), leading to an intense feeling of urination, and incontinence if the person does not reach the bathroom on time. the syndrome is known as overactive bladder syndrome, and it's related to dysfunction of the detrusor muscle. children voiding dysfunction main article: enuresis urination, or voiding, is a complex activity. the bladder is a balloon-like muscle that lies in the lowest part of the abdomen. the bladder stores urine then releases it through the urethra, the canal that carries urine to the outside of the body. controlling this activity involves nerves, muscles, the spinal cord and the brain. the bladder is made of two types of muscles: the detrusor, a muscular sac that stores urine and squeezes to empty, and the sphincter, a circular group of muscles at the bottom or neck of the bladder that automatically stays contracted to hold the urine in and automatically relax when the detrusor contracts to let the urine into the urethra. a third group of muscles below the bladder (pelvic floor muscles) can contract to keep urine back. a baby's bladder fills to a set point, then automatically contracts and empties. as the child gets older, the nervous system develops. the child's brain begins to get messages from the filling bladder and begins to send messages to the bladder to keep it from automatically emptying until the child decides it is the time and place to void. failures in this control mechanism result in incontinence. reasons for this failure range from the simple to the complex. diagnosis ultrasound of the urinary bladder of an 85-year-old man. it shows a trabeculated wall, which is a sign of urinary retention. the pattern of voiding and urine leakage is important as it suggests the type of incontinence. other points include straining and discomfort, use of drugs, recent surgery, and illness. the physical examination looks for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause. other tests include: stress test – the patient relaxes, then coughs vigorously as the doctor watches for loss of urine. urinalysis – urine is tested for evidence of infection, urinary stones, or other contributing causes. blood tests – blood is taken, sent to a laboratory, and examined for substances related to causes of incontinence. ultrasound – sound waves are used to visualize the kidneys and urinary bladder, assess the capacity of the bladder before voiding, and the remaining amount of urine after voiding. this helps know if there's a problem in emptying. cystoscopy – a thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder. urodynamics – various techniques measure pressure in the bladder and the flow of urine. people are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, noting times and the amounts of urine produced. research projects that assess the efficacy of anti-incontinence therapies often quantify the extent of urinary incontinence. the methods include the 1-h pad test, measuring leakage volume; using a voiding diary, counting the number of incontinence episodes (leakage episodes) per day; and assessing of the strength of pelvic floor muscles, measuring the maximum vaginal squeeze pressure. main types there are 4 main types of urinary incontinence: stress incontinence, also known as effort incontinence, is essentially due to incomplete closure of the urinary sphincter, due to problems in the sphincter itself or insufficient strength of the pelvic floor muscles supporting it. this type of incontinence is when urine leaks during activities that increase intra-abdominal pressure, such as coughing, sneezing or bearing down. urge incontinence is an involuntary loss of urine occurring while suddenly feeling the need or urge to urinate, usually secondary to overactive bladder syndrome. overflow incontinence is the incontinence that happens suddenly without feeling an urge to urinate and without necessarily doing any physical activities. it is also known as under-active bladder syndrome. this usually happens with chronic obstruction of the bladder outlet or with diseases damaging the nerves supplying the urinary bladder. the urine stretches the bladder without the person feeling the pressure, and eventually, it overwhelms the ability of the urethral sphincter to hold it back. mixed incontinence contains symptoms of multiple other types of incontinence. it is not uncommon in the elderly female population and can sometimes be complicated by urinary retention. other types functional incontinence occurs when a person recognizes the need to urinate but cannot make it to the bathroom. the loss of urine may be large. there are several causes of functional incontinence including confusion, dementia, poor eyesight, mobility or dexterity, unwillingness to the toilet because of depression or anxiety or inebriation due to alcohol. functional incontinence can also occur in certain circumstances where no biological or medical problem is present. for example, a person may recognize the need to urinate but may be in a situation where there is no toilet nearby or access to a toilet is restricted. structural incontinence: rarely, structural problems can cause incontinence, usually diagnosed in childhood (for example, an ectopic ureter). fistulas caused by obstetric and gynecologic trauma or injury are commonly known as obstetric fistulas and can lead to incontinence. these types of vaginal