Urinary Incontinence
Incontinence is common, costly, and eminently treatable once you name the type — because the type points directly to the mechanism and the treatment.
The big picture
Incontinence is common, costly, and eminently treatable once you name the type — because the type points directly to the mechanism and the treatment. The two big ones, stress and urgency incontinence, have opposite causes: stress is an outlet problem (the sphincter can't hold against a pressure rise), while urgency is a bladder problem (the detrusor contracts when it shouldn't). Get the type right and the management follows almost automatically.
The framework: the types — stress (SUI), urgency (UUI), mixed, overflow, total — each with its mechanism and stepwise treatment, starting conservative and escalating.
Mechanism pathway
Tap any step to see why it happens.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Board traps
Stress = outlet problem (leak on cough/strain); urgency = bladder problem (leak after urge). Opposite mechanisms.
SUI is from urethral hypermobility or intrinsic sphincter deficiency → pelvic floor exercises, then midurethral sling.
UUI is detrusor overactivity → behavioural + antimuscarinic/β-3; refractory → Botox/neuromodulation.
Overflow incontinence comes from a chronically full, poorly emptying bladder — treat the retention, don't just give a bladder relaxant.
Continuous leakage → think fistula (total incontinence).