Urinary incontinence is the involuntary loss of urine. It is common in women of all ages, with prevalence rates of 17-55% of all older women and 12-42% of middle aged and younger women.
There are four types of urinary incontinence: urge incontinence, stress incontinence, overflow incontinence, and mixed incontinence (mixture of stress and urge). Urge incontinence involves incontinence accompanied with urgency. Triggers include running water, hand washing, and cold water exposure. It is often caused by detrusor over-activity. Stress incontinence is triggered by effort, exertion, sneezing, coughing, laughing, or any increase in intra-abdominal pressure. It is due to urethral-sphincter incompetence. Overflow incontinence is a result of incomplete bladder emptying due to impaired detrusor contractility or bladder outlet obstruction (scarring, organ prolapse).
Incontinence may have 3 different origins: the GU system, systemic diseases, and reversible conditions such as medication (estrogen, sedatives, alpha blockers) or drugs. GU causes can be detrusor over activity or incompetence, urethral sphincter incompetence. Systemic issues include CHF, neurologic disorders, diabetes, and cancer.
All women presenting with incontinence should have a thorough H&P including pelvic exam. Referral should be made in the case of abnormal physical exam (pelvic mass or prolapsed pelvic organ), hematuria without UTI, vesicovaginal fistula, associated pelvic pain, or complex neurologic conditions.
Treating urinary incontinence can lead to improved quality of life, therefore, thorough screening of urinary issues as well as screening for anxiety and depression are an important part of patient assessment.