Urinary incontinence

Urinary incontinence is a urinary disorder characterized by the involuntary release of urine through the urethra or through a fistula connecting the urinary tract to the body surface. It is a symptom or sign, not a diagnosis in itself.

Epidemiology

Epidemiological studies have established a high prevalence of urinary incontinence among the population - approximately 1%. Among patients over 65 years of age, 10-20% of the general population suffer from urinary incontinence. Women suffer more often than men.

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Forms

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Urgent urinary incontinence

Urgent urinary incontinence is the loss of urine associated with a strong desire to defecate. Causes may include: inflammatory diseases of the bladder mucosa, bladder tumors, stones in the intravesical part of the ureter, bladder catheterization.

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Stress urinary incontinence

Stress urinary incontinence is the loss of urine associated with increased intra-abdominal pressure in the absence of contraction of the muscle that expels urine. Causes: insufficient resistance of the urethral and pelvic floor muscles during the passage of urine during physical activity (running, walking, climbing stairs, coughing, sneezing, etc.) more often in women who have given birth in the postmenopausal period, in men after operations for hypertrophy or carcinoma of the prostate gland.

Overflow urinary incontinence

Overflow incontinence is the loss of urine when the bladder is full and urine leaks out in small, frequent spurts.

Reasons:

1. urological diseases;
2. neurological - polyneuropathy, mainly affecting autonomic fibers (diabetic, in primary amyloidosis, paraproteinemia), acute and subacute autonomic neuropathy, Shy-Drager syndrome, destruction of the sacral parasympathetic center of the bladder (trauma, tumor, multiple sclerosis, disc herniation, ischemia, sometimes lumbosacral syringomyelia), while important diagnostic symptoms are decreased tone of the external anal sphincter, absence of bulbocavernous and anal reflexes, numbness and hypoesthesia in the anogenital area, fecal incontinence, impotence in men; damage to the cauda equina caused by a tumor (lipoma, neurinoma, ependymoma, dermoid), median lumbar disc herniation; multiple and diffuse damage (injury) of the pelvic nerves observed in retroperitoneal extension of tumors (rectal carcinoma, carcinoma of the prostate gland and genital organs in women), after extensive surgical operations in the pelvic cavity; tabes dorsalis;
3. psychogenic causes.

True urinary incontinence

True urinary incontinence is a nearly constant loss of urine with or without accumulation of a small amount in the bladder. The causes of true urinary incontinence are essentially the same as the causes of overflow incontinence in cases where neurological causes are involved. The phenomenon of overflow incontinence is associated with the preservation of the elasticity of the bladder neck, which resists the pressure of urine, which delays its release. In these cases, the bladder is overfilled, stretched, and urine is released drop by drop, mechanically stretching the neck. With true incontinence, urine is released continuously drop by drop as it enters the bladder, without accumulating in it.

Reflex urinary incontinence

Reflex urinary incontinence is the loss of urine associated with abnormal reflex activity, manifested by the absence of the usual sensation of the need to empty oneself. There is no regulation of the act of urination, an automatic, reflex type of bladder emptying is established due to the independent activity of the spinal centers. This type of urination disorder is observed in multiple sclerosis, spinal cord injury above the level of the conus, tumors of the cervical and thoracic spine, in children under a certain age, and in pernicious anemia.

Extraurethral incontinence

Extraurethral urinary incontinence is the loss of urine through abnormal communication of the urinary canal with the body surface. It occurs in urological pathology.

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Complications and consequences

Urinary incontinence can become a serious psychological problem for both the patient and his family members. About 70% of such patients cannot find a job.

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