Urinary incontinence
| Urinary incontinence | |
|---|---|
| Classification and external resources | |
| Specialty | Gynecology, urology |
| ICD-10 | N39.3-N39.4, R32 |
| ICD-9-CM | 788.3 |
| DiseasesDB | 6764 |
| MedlinePlus | 003142 |
| eMedicine | med/2781 |
| Patient UK | Urinary incontinence |
| MeSH | D014549 |
Urinary incontinence (UI), also known as involuntary urination, is any leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It is twice as common in women as in men. Pregnancy, childbirth, and menopause are major risk factors. It has been identified as an important issue in geriatric health care. Urinary incontinence is often a result of an underlying medical condition but is under-reported to medical practitioners.Enuresis is often used to refer to urinary incontinence primarily in children, such as nocturnal enuresis (bed wetting).
There are four main types of incontinence:
Treatments include pelvic floor muscle training, bladder training, and electrical stimulation. The benefit of medications is small and long term safety is unclear.
The most common types of urinary incontinence in women are stress urinary incontinence and urge urinary incontinence. Women with both problems have mixed urinary incontinence. After menopause, estrogen production decreases and in some women urethral tissue will demonstrate atrophy with the tissue of the urethra becoming weaker and thinner. Stress urinary incontinence is caused by loss of support of the urethra which is usually a consequence of damage to pelvic support structures as a result of childbirth. It is characterized by leaking of small amounts of urine with activities which increase abdominal pressure such as coughing, sneezing and lifting. 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 . It is characterized by leaking of large amounts of urine in association with insufficient warning to get to the bathroom in time.
Continence and micturition involve a balance between urethral closure and detrusor muscle activity. Urethral pressure normally exceeds bladder pressure, resulting in urine remaining in the bladder. The proximal urethra and bladder are both within the pelvis. Intra abdominal pressure increases (from coughing and sneezing) are transmitted to both urethra and bladder equally, leaving the pressure differential unchanged, resulting in continence. Normal voiding is the result of changes in both of these pressure factors: urethral pressure falls and bladder pressure rises.
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