Urinary Incontinence Symptom Evaluation

Creator: Dr. Arun Narayanaswamy
Keywords: Urinary incontinence, loss of bladder control, stress, incontinence, urge incontinence, mixed incontinence, functional incontinence

Author - Dr. Arun Narayanaswamy, MBBS, MS(Gen Surg), DNB(Gen Surg), MCh(Urol), DNB(Urol) , Dr. Talla Veena

Medically Reviewed by Dr. Sunil Shroff, MBBS, MS, FRCS (UK), D. Urol (Lond) on Jun 30, 2023

About

Urinary Incontinence is an uncontrollable urinary leakage. Normally, during urination muscles in the bladder tighten to move urine into the tube-shaped urethra. At the same time, the muscles around the urethra (urinary sphincter) relax and let the urine pass out of the body. When the bladder muscles and / or the sphincter muscles don't work the way they should, urine can leak. It can be temporary or persistent and is more common with aging. Women are more commonly affected compared to men, and this can be attributed to hormonal changes, pregnancy.

Pregnancy Due Date Calculator, childbirth, and anatomy of the urogenital tract. Many women experience urinary incontinence at some stage in their lives and small amount of urine leakage can occur due to laughing or a cough or due to lifting heavy items(1^✔).

Urinary incontinence can cause significant morbidity and lead to depression. It can also cause skin problems. Fortunately, most patients can be effectively treated.

Types of Urinary Incontinence

Stress incontinence - Urine leaks as a result of increased abdominal pressure which occurs with severe physical activity, exercise or lifting heavy object or even with cough or sneezing. Pelvic muscle weakness is the usual cause of stress incontinence.
Urge incontinence - This happens when there is a sudden urge to pass urine, but one is unable to visit the restroom in time due to bladder muscle irritability resulting from Urinary tract infection, Diabetes, and Neurological diseases.
Overflow incontinence - Overflow incontinence occurs due to incomplete emptying of the bladder causing bladder distension with frequent or constant dribbling of urine. It is seen in patients with enlarged prostate, and neurological disorders.
Functional incontinence - It is due to physical or psychological factors that interfere with reaching the restroom in time. Arthritis, Dementia are some of the causes of functional incontinence.
Mixed incontinence - This is a combination of more than one type of incontinence(2^✔).

Causes of Urinary Incontinence

Temporary or short-term causes of incontinence can include:

Urinary tract infections (UTIs) and Incontinence

UTI is accompanied by other symptoms like frequency, dysuria or burning and urgency. It is only when the urgency is uncontrollable that it can lead to incontinence and this is called urge incontinence.

Episodes of UTI or cystitis in young women is not uncommon when they become sexually active. In fact 'Honeymoon Cystitis: The Unexpected Part of Your Vacation' is well recognized that can affect recently married women.

Urinary tract infection in females is more common due to the short urethra and the proximity of the vagina and anal passage.

In male it usually occurs among children or after the age of 50 years.

Prostatitis affects men

It is the inflammation of the prostate gland. Common symptoms include increased frequency, urgency, dysuria, nocturia, weak stream, incomplete voiding, fever, chills, fatigue, muscle pains, and joint pains. The urgency can occasionally cause incontinence.

Urine analysis with culture, fractional urine studies with cytology, and transrectal ultrasound to check the prostate morphology are useful in making a diagnosis(3^✔).

Pregnancy too can Cause incontinence

During pregnancy, the uterus places extra pressure on the bladder as it expands and causes incontinence which goes away in the weeks after delivery.

Medications as a cause: Diuretics, Sedatives, muscle relaxants and antidepressants.

Beverages / Food: Certain drinks (coffee, decarbonated drinks and alcohol), Spicy/citrus food, and Artificial sweeteners can lead to urgency and urge incontinence.

If the incontinence is long stranding and chronic further investigation maybe required to establish the diagnosis.

Urinary Incontinence Symptom due to Neurological problems

These include Stroke, Spinal injury, Parkinson's disease, Alzheimer's disease, Multiple sclerosis, Brain tumor, among others can lead to urinary incontinence by interfering with the nerve signal that acts on the bladder/sphincter(4^✔).

Multiple sclerosis and urinary incontinence

Multiple sclerosis is an immune-related inflammatory disorder affecting the central nervous system. It commonly presents with paresthesias, muscle cramping, bladder/bowel/sexual dysfunction, optical neuritis, ataxia, tremors, dysarthria, facial twitching with weakness, heat intolerance, cognitive problems, among others. The diagnosis is based on the clinical presentation and investigations. Magnetic resonance imaging (MRI) of the brain and spine, and lumbar puncture with Cerebrospinal Fluid (CSF) analysis usually help in concluding the diagnosis. Cerebrospinal Fluid (CSF) analysis shows oligoclonal bands and intrathecal immunoglobulin G(5^✔).

Spinal cord neoplasms as a cause of incontinence:

It is the tumor (primary tumor or metastatic tumor that has spread to the spinal cord) of the spinal cord causing compression of the cord, or the nerves that arise from the spinal cord innervating various organs like bladder, bowel, among others. The presentation varies depending upon the affected nerve.

Bowel dysfunction presents with urinary hesitancy, urinary incontinence or urinary retention. The diagnosis may be done with plain X - rays, MRI of the spine, nuclear scan of the spine, and by checking the post-voidal residual volume.

Spinal epidural abscess:

It is the abscess in the epidural space of the spinal cord, which causes compression of the cord due to expansion leading to sensory and motor symptoms. Common symptoms related to bladder dysfunction include urinary hesitancy, urgency, incontinence, or retention of the urine Blood investigations and MRI of the spine are helpful in forming a diagnosis.

Spinal cord trauma as a cause of urinary incontinence:

This kind of trauma can result in sensory, motor, and autonomic dysfunction. The presentation varies depending on the level of the injury. The loss of bladder control can result in urinary incontinence or incomplete voiding of the bladder.

Along with the history, plain X-ray of spine, MRI of the spine and measurement of the post-void residual volume using ultra sound helps in forming a diagnosis.

Long standing Diabetes:

The incontinence is due to increased production of urine and also due to peripheral neuropathy that can affect the bladder function.

Pelvic Floor Disorders and Incontinence

Weakness of pelvic floor muscle in women is often caused by child birth
As the women age the hormonal changes after menopause can make the muscles even weaker. This can results in incontinence of both urine and bowel(6^✔).

Uterine prolapse:

It is the descent of the uterus from its normal position through the pelvis into the vagina.

Common symptoms include feeling pressure in the pelvis with pain, pain during intercourse, urinary incontinence, feeling of urgency/frequency, excessive vaginal discharge, and protrusion of the tissue through the vagina. Pelvic ultrasound and blood investigations are helpful in forming a diagnosis.

Following prostate cancer surgery

After prostate surgery sometimes the urinary sphincter maybe damaged and can lead to incontinence.

After endoscopic or radical surgery of the prostate for cancer the sphincter muscle can get damaged leading to stress incontinence. This may require continence pads for a few days or months(7^✔).

Urinary incontinence is a symptom that can be seen in various conditions like:

Obstruction and Urinary Incontinence

Enlarged prostate:

This condition can cause in men over 50 years to suffer from frequency during both day and night, prolonged voiding, urgency and urge incontinence.

Constipation:

can exert pressure on the bladder and can lead to incontinence.

Diagnosis of Urinary Incontinence

Medical history:

Frequency of urination, how often does leak happen and how much urine leaks each time, and how long have symptoms been present are some of the questions asked. While at home, it might be recommend to keep track of any leakage in a journal for a few days. All this information can help establish a pattern with leakage, which often points to a specific type of incontinence. History of other medical conditions and medications is also very important.

Physical exam:

To look for any physical reason that could be causing the incontinence. This could include looking for a distended bladder, neurological signs, doing a pelvic exam in women and checking the size of prostate in men.

Urine samples:

Urine analysis and Culture to test for infections or blood.

Ultrasound:

This is a painless test that uses sound waves to create an image of your internal organs. This imaging test will allow to look at the bladder / prostate and assess the emptying ability of your bladder in a non-invasive way.

Stress test:

During this test, the patient is asked to cough to see if any urine leaks due to this action.

Cytoscopy:

A cystoscope is a thin flexible tube with a camera on the end that can be inserted into your urethra and bladder to get a close look at the inside the lower urinary tract.

Urodynamic testing:

This testing involves several tests that check how much the bladder can hold and how well the urethral sphincter muscle is working. This testing may involve inserting a tube into the bladder that will fill the bladder up with fluid and measure the pressure in the bladder.

Pad test:

Patient is given a pad to wear, which will catch any leaked urine. At the end of the test, this pad is weighed to see how much urine was lost(8^✔).

Frequently Asked Questions

1. Which doctor should I consult in case of Urinary incontinence?

It is best to consult a Urologist.

2. Who is at increased risk of getting urinary incontinence?

Factors like aging, obesity, diabetes, women (due to pregnancy, child birth, menopause, and female anatomy that lead to loss of strength in the pelvic muscles), and neurological disorders increase the risk of developing urinary incontinence.

3. What are the types of urinary incontinence?

Depending upon the mechanism causing urinary incontinence, there are various types. They are:

Stress incontinence
Urge incontinence/Overactive bladder
Functional incontinence
Overflow incontinence
Mixed incontinence
Transient incontinence

4. How is urinary incontinence diagnosed?

Urinary incontinence is diagnosed on the basis of symptoms, such as how often you are required to empty the bladder, when is it happening, and how often are you experiencing it, history of other medical conditions that you are having, medications that you are on, and related investigations. Tests like ultrasound abdomen, cystoscopy, urine analysis, and urodynamic studies are useful in concluding the cause for urinary incontinence.

5. What are the treatment options available for urinary incontinence?

Treatment may be with behavioural treatment, drugs, devices, and surgery. Certain lifestyle changes can also help cope with this situation.

References:

Urinary Incontinence in Older Adults - (https://www.nia.nih.gov/health/urinary-incontinence-older-adults#)
Urinary Incontinence - (https://www.ncbi.nlm.nih.gov/books/NBK559095/)
Overview of Overactive Bladder, Prostatitis, and Lower Urinary Tract Symptoms for the Primary Care Physician - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472848/)
Urinary Incontinence in Neurological Disease - (https://www.ncbi.nlm.nih.gov/books/NBK132842/)
Urinary incontinence in multiple sclerosis: prevalence, severity and impact on patients' quality of life - (https://pubmed.ncbi.nlm.nih.gov/27120000/)
Pelvic floor dysfunction - (https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/pelvic-floor)
Post-prostatectomy incontinence: Etiology, evaluation, and management - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548645/)
Diagnosis of Bladder Control Problems - (https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems/diagnosis)

Cite this Article ⇣⇡

Please use one of the following formats to cite this article in your essay, paper or report:

APA
Dr. Arun Narayanaswamy. (2023, June 30). Urinary Incontinence - Symptom Evaluation. Medindia. Retrieved on Jan 29, 2025 from https://www.medindia.net/health/conditions/urinary-incontinence.htm.
MLA
Dr. Arun Narayanaswamy. "Urinary Incontinence - Symptom Evaluation". Medindia. Jan 29, 2025. <https://www.medindia.net/health/conditions/urinary-incontinence.htm>.
Chicago
Dr. Arun Narayanaswamy. "Urinary Incontinence - Symptom Evaluation". Medindia. https://www.medindia.net/health/conditions/urinary-incontinence.htm. (accessed Jan 29, 2025).
Harvard
Dr. Arun Narayanaswamy. 2023. Urinary Incontinence - Symptom Evaluation. Medindia, viewed Jan 29, 2025, https://www.medindia.net/health/conditions/urinary-incontinence.htm.