1. Urinary Incontinence
Involuntary loss of urine that is objectively demonstrable and is a social or hygienic problem.
Affects physical, psychological, social well being → Reduce quality of life
Prevalence, ↑ with age
Common in institutionalized women, those in residential nursing homes

2. Some definitions…
Stress incontinence is loss of urine on physical effort
Urge Incontinence is an involuntary loss of urine associated with a strong desire to void.
Overflow Incontinence occurs without any detrusor effort when the bladder is over-distended.
Urgency is a sudden desire to void
Frequency is passing of urine seven or more/day or being awoken from sleep more than once a night to void.

4. Classification of Incontinence
EXTRA URETHRAL CAUSES
Congenital causes
Fistula
URETHRAL CAUSES
Urethral Sphincter Incompetence (Urodynamic stress Incontinence)
Detrusor overactivity/Unstable bladder (Nueropathic or non-nueropathic)
Retention with overflow
Congenital causes
Miscellaneous

5. 2B: FISTULA Abnormal opening between the urinary track and outside.
Obstetric cause: Obstructive labour with compression of bladder between presenting head and bony pelvis
Gynecological cause: AW pelvic surgery, radiotherapy, pelvic malignancy
Treated by primary closure or surgery

6. INVESTIGATIONS Urine C&S- tro Infections Pad test
Measure Postvoidal Residual Volume by bladder ultrasound or urethral catheter >100mL in more than one occasion→+
Cough Stress Test. 250mL into bladder
Abdominal leak point pressure

7. Urodynamic studies Cystogram Cystoscopy
Uroflowmetry. Bladder outlet obstruction
Cystometry. Detrusor activity, differentiate involuntary detrusor contraction or increase intraabdominal pressure
Cystogram
Stress incontinence, Cystocele, Sphincter activity, fistula
Cystoscopy
Tumors, stones

8. Treatment
Palliative – Fluid restriction, Protective perineal pads, Bladder retraining, Pelvic Floor exercise (Kegel)
Devices – Weighted vaginal cones, Vaginal pessaries, contraceptive diaphragms
Surgery – to restore the proximal urethra and bladder neck to zone of intraabdominal pressure transmission and to increase urethral resistance
Colposuspension Operation, Artificial Sphincter