Types of Urinary Incontinence

Stress Incontinence

• Cause: Weak pelvic floor muscles → urethral hypermobility
• Triggers: Coughing, sneezing, laughing, physical activity
• Common in: Women post-vaginal delivery, menopause
• Leak with: ↑ Intra-abdominal pressure
• Tx:
  • First-line: Pelvic floor exercises (Kegels)
  • Pessary
  • Surgical: Midurethral sling

Urge Incontinence (Overactive Bladder)

• Cause: Detrusor overactivity
• Symptoms: Sudden urge to void + involuntary leakage
• Triggers: Running water, cold weather, key in door
• Common in: Elderly, neurological disease (MS, stroke)
• Tx:
  • Behavioral: Bladder training
  • Meds:
    • Antimuscarinics (oxybutynin)
    • β3-agonists (mirabegron)

Overflow Incontinence

• Cause: Incomplete bladder emptying → retention + overflow
• Etiologies:
  • Neurogenic bladder (DM, MS, spinal injury)
  • Obstruction (BPH, urethral stricture)
• Symptoms: Constant dribbling, weak stream, ↑ PVR
• Dx: Postvoid residual (PVR) > 200 mL
• Tx:
  • Intermittent catheterization
  • Address underlying cause (e.g., tamsulosin for BPH)

Functional Incontinence

• Cause: Inability to reach toilet in time (cognitive/physical impairment)
• Common in: Dementia, delirium, immobility
• Tx: Toileting schedule, caregiver assistance

Mixed Incontinence

• Combination of stress + urge symptoms
• Tx: Treat predominant symptom first