Introduction and Definitions

Urinary incontinence (UI), according to the International Continence Society (Haylen et al., 2010), is defined as the involuntary loss of urine. It simultaneously exists as a symptom or complaint, sign, or finding and defined condition. Within the broad context of lower urinary tract symptoms (LUTS), UI is considered a storage symptom as opposed to a voiding symptom: “storage” refers to the filling phase of the micturition cycle, whereas “voiding” refers to the emptying phase.

The most commonly recognized subtypes of UI are stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence (MUI). SUI is the involuntary loss of urine associated with effort or physical exertion (e.g., sporting activities) or sneezing or coughing. UUI is the involuntary loss of urine associated with urgency, a sudden, compelling desire to pass urine that is difficult to defer. MUI is a combination of the former two—the involuntary loss of urine associated with urgency and with effort or physical exertion or sneezing or coughing. Other types of UI include functional UI, related to inability to reach the toilet in an otherwise normal urinary system; overflow UI, resulting from bladder overdistention or retention; and enuresis, insensible and continuous incontinence.

Symptoms and findings of UI often coexist with other, associated LUTS, including symptoms related to storage and voiding. Overactive bladder (OAB) syndrome is the constellation of multiple storage symptoms predicated by urinary urgency, usually accompanied by frequency and nocturia, with or without UUI, in the absence of urinary tract infection (UTI) or other obvious pathology. Frequency, urgency, and nocturia can also occur separately. Voiding symptoms that may coexist with UI include hesitancy, slow or weak urinary stream, straining to void, incomplete bladder emptying, dysuria, and retention. Pain, either specific to pelvic organs (e.g., bladder, urethra, vaginal, rectal/anal) or generalized, can also occur.

Voiding dysfunction is a diagnosis made on the basis of symptoms and clinical findings and defined as abnormally slow or incomplete micturition, including acute or chronic urinary retention. It most typically occurs in women as an adverse outcome after invasive treatment for SUI or other pelvic floor conditions.

UI and LUTS often occur in women in association with other pelvic floor conditions, including pelvic organ prolapse (POP). SUI is commonly found in women with POP, although as the degree of POP increases, SUI becomes less apparent, and other LUTS may develop. Often SUI can be demonstrated in this scenario by reducing the POP and testing for SUI. When SUI is observed only after the reduction of coexistent prolapse, it is referred to as occult or potential SUI.

Epidemiology and Economic Impact

UI is a common condition in women. Estimates vary by definition, but approximately 25% to 75% of women report some UI. In the United States, approximately half of surveyed women report some UI, whereas 16% report UI of at least moderate severity. Projections of prevalence based on population growth suggest that the number of U.S. women with UI will increase by more than 50% (from 18 million to 28 million women) from 2010 to 2050. Minassian et al. (2008) reported that 23% to 38% of the female population in the United States older than age 20 admit to symptoms of SUI. It is estimated that 7% to 10% of women affected perceive SUI as being severe with frequent leakage (Thom et al., 2005). Analysis of Medicare data suggests that only approximately 10% of women diagnosed with SUI undergo surgical correction (Anger et al., 2009).

SUI is the most common subtype of UI reported by women: about 50% of women with UI report SUI as the primary or sole symptom of incontinence. About one third of women with UI have MUI, and 15% have UUI alone. Concurrent POP or fecal incontinence or both are common, occurring in 23% of women with UI. Even when UI is recognized, a substantial number of women do not receive a formal diagnosis or do not seek treatment. Of women with no prior diagnosis of UI, 50% report some degree of urine leakage.

Related posts:

Mixed and Recurrent Incontinence, Incontinence in Patients with Pelvic Organ Prolapse, and How Best to Avoid and Manage Complications: Case Discussions Single-Incision Synthetic Midurethral Slings Retropubic Synthetic Midurethral Slings Surgical Anatomy of the Anterior Vaginal Wall, Retropubic Space, and Inner Groin Surgical Management of Voiding Dysfunction and Retention After Stress Incontinence Surgery Sacral Neuromodulation

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