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Urinary Incontinence

Urinary incontinence is defined as objectively demonstrable involuntary loss of urine so as to cause hygienic and/ or social inconvenience for day-to-day activity.






1. SUI

2. Urge incontinence

3. Mixed

4. Overflow incontinence

1. Acquired


 e.g., VVF, urethral-vaginal fistula

2. Congenital e.g., ectopic ureter


Types of Urinary Incontinence


Stress urinary


Urge urinary


Mixed incontinence



Bypass incontinence

It is involuntary escape

of urine when intra

abdominal pressure

is increased as in sneezing or coughing

or laughing.


Involuntary leakage

accompanied by or

immediately preceeded

by the urge to void.


Both SUI and urge

incontinence together


It is associated with cognitive,

psychological or physical impairment that makes it difficult to reach the toilet.


May be caused by

urogenital fistula or any congenital abnormality


It is the most common

variety of urinary



Involuntary detrusor

muscle contractions are typically the cause

of urge incontinence.



A useful mnemonic for functional incontinence


D = Delirum

I = Infection

A = Atrophy

P = Pharmacological


E = Endourinopathy

R = Restricted mobility

S = Stool impaction



Stress Urinary Incontinence


Stress urinary incontinence (SUI) is defined as involuntary escape of urine from external urinary meatus due to sudden rise in intra-abdominal pressure (coughing, sneezing, etc.).



- Bladder neck descent + urethral hypermobility (75 – 80%)


- Intrinsic sphincter defect (20-25%)


Causes of SUI

  • Prolapse uterus
  • Postmenopausal atrophy
  • Childbirth trauma
  • Pregnancy

Tests for SUI

  • Bonney's test is used to demonstrate SUI and find out the cause for it. In a patient with SUI, two fingers are inserted m the paraurethral region and the bladder neck is lifted up, and then the patient is asked to cough. If SUI gets corrected, then it is due to bladder neck descent urethral hypermobility. If SUI persists, it is due to intrinsic sphincter defect.
  • Marchetti test is same as Bonney's test, except that instead of two fingers two Allis forceps are used.
  • Q tip test: A sterile cotton swab is introduced into the level of bladder neck. Then the patient is asked to strain.
    Marked upward elevation of cotton tip (>30°) indicates urethral hypermobility. Goniometer is used to measure the urethero-vesicle angle.
  • Urethral pressure profile test: During strain there is a significant lowering of urethral closure pressure.
  • Leak point pressure test: The patient is asked to strain, and the minimum pressure (cm of water) at which leakage is observed is recorded as valsalva leak point pressure. This gives us an idea of the strength of sphincter.

Surgeries of SUI


Midurethral Sling

Newer Surgeries for SUI


TVT: tension-free vaginal type


TOT: Transobturator tape


Urge Incontinence



Motor (Detrusor Overactivity/Instability)

• UTI/ cystitis/ trigonitis

• Cerebrovascular accident

• Urethral obstruction

• Alzheimer's disease

• Bladder stones

• Parkinsonism

• Bladder cancer

• Multiple sclerosis

• Sub urethral diverticula

• Diabetes

• Foreign bodies

• Peripheral neuropathies


• Autonomic neuropathies


• Cauda equina lesions


Investigation of Urge Incontinence

  • Urine culture (to rule out infection)
  • Cystourethroscopy (to rule out causes like bladder tumor/ calculus)
  • Cystometry: Main objective is to rule out urge incontinence

Drugs Useful in Treating Detrusor Overactivity (Anticholinergic)

  1. Tolterodine
  2. Hyoscyamine sulfate
  3. Oxybutynin chloride
  4. Dicyclomine hydrochloride

Clinical Features


Stress Incontinence

Urge Incontinence (Sensory)

Detrusor Instability

Leakage of urine coincides

Unable to control the escape of

The incontinence may occur abruptly

with stress

urine once there is urge to void

even without a full bladder

No prior urge to void






Patient-fully aware of it

Patient-aware of the urge

Patient-not aware of it


Urgency and frequency

Frequency and nocturia

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