-IBIS-1.7.0-
tx
urinary system
urinary incontinence
Diagnoses

definition and etiology

definition:

The loss of voluntary control over urination during the day and night.

etiology:

There are many types of urinary incontinence.

• Urge incontinence: This type of UI is preceded by a morbid desire to urinate. Common causes are bladder infections; idiopathic; spina bifida occulta; multiple sclerosis; and bladder stones.

• Stress incontinence: This UI occurs following sneezing, coughing, laughing, and straining (activities that increase intra-abdominal pressure) and is due to a somewhat compromised urinary sphincter. It seems to be more common in post-menopausal women due to atrophy of the urethra; although, it can occur in men after prostatic surgery.

• Overflow (paradoxical) incontinence: This occurs when the pressure of an overfilled bladder eventually overcomes sphincter resistance. The bladder becomes dilated and palpable.

Factors involved with this type of UI include obstruction to urine outflow (BPH and prostate cancer); urethral meatus stricture (in kids, esp.); urethral strictures; and injury to the spinal cord.

• Ectopic ureter in women: Patients present with leakage day and night their whole lives, even though they void normally. The ureter may be found in the vagina, near the bladder neck, or in the urethra, and surgical correction is necessary. Ectopic urethra in men does not produce UI.

• Psychogenic incontinence: Particularly seen in children, this is characterized by a child with normal ability to urinate, but who fakes incontinence to gain some emotional need. A careful diagnostic work-up will uncover no pathology.

• Functional incontinence: This mainly occurs in elderly patients who have good working urinary parts, but cannot reach the toilet in time due to confusion, drugs, or an inability to walk well.

• Urinary fistulae: Usually seen in women following some type of body trauma (gunshot wound, automobile accidents, neoplasms), where a tract develops either from the ureter, bladder, or urethra and empties into the vagina.

• Neurogenic bladder dysfunction: This is due to congenital abnormalities, injuries, or diseases of the brain, spinal cord or nerves supplying the bladder.

• Mixed types of incontinence.

signs and symptoms

signs and symptoms:

• Involuntary loss of urine.

• Other symptoms pertaining to the primary cause of the incontinence.

lab findings:

• Tests are necessary for a full work-up of the condition, unless the cause is obvious (after a spinal cord transection injury, for example).

course and prognosis

Depends on the type of incontinence. In psychogenic incontinence there is a good prognosis for full return of urinary control as well as if the incontinence is due to a correctable anatomic abnormality. Others causes can be harder to treat.

differential diagnosis

• determine the cause

footnotes