The different kinds of urinary incontinence

Learn more about stress, urge, overflow and total urinary incontinence:

Stress urinary incontinence
In stress urinary incontinence, the continence mechanism can't deal with elevations in intra-abdominal pressure. The intra-abdominal pressure is transmitted onto the bladder, causing urine to leak from the urethra. People with this form of incontinence are classically dry while sitting still or lying down.

Activities like coughing, sneezing, lifting of heavy objects or getting up from a chair causes an increase in intra-abdominal pressure that's associated with leakage of urine. In very mild cases only a few drops of urine are lost with strenuous activity. In severe cases large amounts of urine can leak with moderate increases in intra-abdominal pressure.

Urge incontinence
Urge incontinence is caused by the inability of the bladder to store adequate amounts of urine for long enough between voiding. The bladder is either too small or unstable.

The classic symptom is a great desire to urinate that can't be suppressed. The patient leaks urine before getting to a toilet.

Urge incontinence is associated with the frequent passage of urine during the day (frequency) and night (nocturia). Bladder muscle instability caused by pathology in the bladder, such as infection, stones or tumour, is often associated with burning urine (dysuria) and blood in the urine (hematuria). Bladder pain is common with infections, stones and interstitial cystitis.

Overflow incontinence
In overflow incontinence the bladder is chronically distended and permanently full of urine. The kidneys continue to produce urine and the excess "spills" out of the bladder. The incontinence is usually a persistent low-level leakage, which is often worse at night.

People with this kind of incontinence are still able to pass urine, but only pass small amounts with difficulty. They often complain of a poor stream, straining while passing urine and a feeling of incomplete emptying.

Total incontinence
A vesicovaginal fistula is an abnormal communication between the bladder and the vagina. With large fistulae, there's a constant leakage of all of the urine via the vagina. A person with a tiny fistula may pass urine in the normal way, as well as suffer from a constant leak from the vagina.

An ureterovaginal fistula is an abnormal communication between the ureter and the vagina. Urine from the kidney on the affected side will continuously leak out. If the opposite ureter and the bladder are normal, the person will pass the urine coming from the unaffected side in the normal manner.

An ectopic ureter is a congenital (born with) abnormality in which the ureter opens in an abnormal position. Depending on the position of the opening, it can cause incontinence in females but not in males. If only one side is affected, the person passes urine in the normal manner, while also suffering from a continuous leak.

Symptoms are present from birth.
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