OVERVIEW

What is urinary incontinence?

In simple terms, urinary incontinence refers to the involuntary leakage of urine from the urethra. The bladder's function is to store urine, which requires both normal bladder expansion and the proper tight closure of the urinary control valve. When various factors prevent the bladder from expanding or contracting, or when the urinary control valve fails to close tightly, urine will involuntarily leak from the urethra.

There are many causes of urinary incontinence, such as congenital developmental abnormalities, surgery, trauma, and neurological diseases. Different causes require different treatment strategies and have varying prognoses. Treatments for urinary incontinence include conservative therapy, medication, and surgery.

Urinary incontinence can occur in people of any age but is more common in the elderly. This condition can severely affect a patient's quality of life, especially in cases of long-term persistent incontinence.

How common is urinary incontinence?

Urinary incontinence is a common and highly prevalent condition in urology. Statistics show that 23% to 45% of women experience varying degrees of urinary incontinence, with about 7% exhibiting significant symptoms. Urinary incontinence is also relatively common in men, though its incidence is generally lower than in women.

Is urinary incontinence a disease? Is it a normal part of aging?

Urinary incontinence is a pathological condition. Traditional beliefs suggest that only elderly women experience it, but this is not the case—many young people also suffer from it. Additionally, urinary incontinence is not rare among men, such as those with prostate enlargement. The incidence of urinary incontinence increases with age, so it is not merely a normal part of aging.

If urinary incontinence is affecting your daily life, do not hesitate to seek medical attention. For most patients with early-stage urinary incontinence, doctors can recommend simple lifestyle changes or medications to alleviate or even prevent symptoms.

What are the types of urinary incontinence?

Based on symptoms, urinary incontinence can be classified into stress incontinence, urge incontinence, overflow incontinence, true incontinence, and mixed incontinence.

SYMPTOMS

What are the common manifestations of urinary incontinence?

• Stress incontinence: Patients can normally control urination, but urine involuntarily leaks from the urethra during activities that increase abdominal pressure, such as coughing, sneezing, laughing, exercising, or lifting heavy objects. It is more common in women who have given birth or postmenopausal women, as well as in men after prostate surgery.

• Urge incontinence: Patients experience a sudden, strong urge to urinate, followed by involuntary leakage. This is often seen in urinary tract infections or neurological disorders.

• Overflow incontinence: The bladder retains a large amount of urine, and small amounts of urine drip continuously from the urethra without a steady stream. This is commonly associated with chronic lower urinary tract obstruction.

• True incontinence: Patients experience continuous, involuntary urine leakage from the urethra at all times and in any position. The bladder remains empty, and normal urination does not occur. This is often caused by neurogenic bladder, childbirth-related urethral injuries in women, or damage to the external urethral sphincter from prostate surgery.

• Mixed incontinence: A combination of two or more types of incontinence, such as urge incontinence often coexisting with stress incontinence.

What adverse effects can urinary incontinence cause?

• Urinary incontinence can severely impact a patient's quality of life, especially in cases of long-term chronic incontinence.

• It can affect social interactions, work performance, and interpersonal relationships.

• It may lead to local skin issues, such as recurrent rashes, infections, or pressure sores in the moist perineal area.

• It increases the risk of recurrent urinary tract infections.

CAUSES

What are the common causes of urinary incontinence?

The common causes of urinary incontinence include:

• Congenital developmental abnormalities, such as congenital epispadias;

• Trauma, such as pelvic fractures or childbirth injuries in women;

• Surgical complications, such as transurethral resection of the prostate, radical prostatectomy, or hysterectomy;

• Neurological disorders, such as multiple sclerosis, Parkinson's disease, stroke, brain tumors, or spinal cord injuries;

• Urinary tract infections, such as acute cystitis;

• Lower urinary tract obstructions, such as benign prostatic hyperplasia or urethral stones;

• Other factors, such as consuming diuretic foods or medications, constipation, pregnancy, multiple childbirths, aging, menopause, obesity, or smoking.

Who is more prone to urinary incontinence?

• Women are more likely than men to experience urinary incontinence, especially those who are pregnant, have had multiple childbirths, or are going through menopause;

• Middle-aged and elderly individuals are more prone to urinary incontinence compared to younger people;

• Obese individuals are more susceptible to urinary incontinence than those with normal or lower body weight;

• Smokers, those with a family history of urinary incontinence, or individuals with neurological disorders or diabetes are also more likely to develop urinary incontinence.

DIAGNOSIS

What tests are needed for urinary incontinence?

First, a detailed physical examination by the doctor is essential. Additionally, tests such as urinalysis, urinary tract ultrasound, voiding diary, post-void residual measurement, urodynamic studies, cystourethrography, and cystoscopy may be performed. The doctor will select the appropriate tests based on the patient's specific condition.

What precautions should be taken for urinary incontinence-related tests?

• Physical examination: For some patients with urinary incontinence, a simple physical exam combined with medical history can confirm the diagnosis, such as stress urinary incontinence. Note that the doctor will typically ask detailed questions about the course of the condition and may ask you to perform simple actions like holding your breath or coughing during the exam.

• Urinalysis: This can preliminarily determine whether there is a urinary tract infection to rule out incontinence caused by infection. Note that a midstream urine sample (the middle portion of the urine stream) should be collected.

• Urinary tract ultrasound: This helps assess the condition of the urinary system and rule out incontinence caused by issues like urinary stones or prostate enlargement. Note that the ultrasound is best performed with a full bladder.

• Voiding diary: Useful for diagnosing mild or intermittent urinary incontinence and assessing its severity. A detailed voiding diary should record daily fluid intake, urine output, urination times, urgency, and the frequency of incontinence episodes.

• Post-void residual measurement: Helps diagnose lower urinary tract obstruction or neurogenic bladder.

• Urodynamic studies: Evaluates the patient's voiding function.

• Cystourethrography: Uses contrast dye to directly observe the structure of the bladder and urethra, aiding in diagnosing obstructions or strictures. A catheter is temporarily inserted during the procedure, which may cause discomfort. Doctors usually apply a lubricant containing local anesthetic to minimize discomfort.

• Cystoscopy: For patients suspected of having bladder diverticula, tumors, or vesicovaginal fistulas, this endoscopic examination allows direct visualization of the affected area.

Which conditions are easily confused with urinary incontinence? How to differentiate them?

Urinary incontinence is often confused with urine leakage and enuresis.

• Urine leakage refers to urine exiting through abnormal channels, such as the vagina or rectum, rather than the urethra.

• Enuresis refers to involuntary urination during sleep, commonly seen in children.

TREATMENT

Which department should patients with urinary incontinence visit?

Urinary incontinence is a common and highly prevalent condition in urology, so patients should seek treatment at the urology department. Female patients with stress urinary incontinence may also visit the gynecology department.

Do patients with urinary incontinence need treatment?

If you experience symptoms of urinary incontinence, prompt medical attention and active treatment are necessary. For most early-stage patients, simple lifestyle changes or medication can alleviate or even prevent incontinence, significantly improving quality of life.

What are the treatment options for urinary incontinence?

Treatment includes conservative therapy, medication, and surgery.

The approach depends on the type, severity, and underlying cause of incontinence, often requiring a combination of methods. If caused by an underlying condition, treating the primary disease is prioritized. Minimally invasive treatments are preferred initially, with more invasive or surgical options considered if ineffective.
Conservative treatments:

• Weight control;
• Pelvic floor muscle training;
• Bladder training;
• Biofeedback;
• Lifestyle adjustments;
• Electrical stimulation therapy;
• Magnetic stimulation therapy;
• Medical device therapy;
• Interventional therapy.

Medications:

• Duloxetine;
• Estrogen;
• Selective α1-adrenergic receptor agonists;
• Anticholinergic drugs;
• Alpha-blockers.

Surgical treatments:

• Retropubic urethropexy;
• Sling procedures;
• Bladder neck bulking agent injections.

What medications can treat urinary incontinence?

Medications are mainly used for mild to moderate cases, with varying treatment durations.

• Duloxetine, often for female stress incontinence, requires at least 3 months of treatment. Common side effects include nausea and vomiting; others are dry mouth, constipation, fatigue, dizziness, and insomnia.
• Estrogen, for female stress incontinence, is only effective vaginally (not orally). Long-term use raises risks of endometrial/ovarian/breast cancer and cardiovascular disease.
• Selective α1-adrenergic agonists (e.g., midodrine) for stress incontinence may cause high blood pressure, nausea, dry mouth, constipation, palpitations, headaches, cold extremities, or even stroke.
• Anticholinergics (e.g., tolterodine) treat urge incontinence.
• Alpha-blockers (e.g., tamsulosin) are used for urge or overflow incontinence.

Should urinary incontinence patients undergo surgery?

• Conservative/medication treatments fail or are intolerable;
• Moderate-severe incontinence severely impacts quality of life;
• Patients with high quality-of-life expectations;
• Those with pelvic organ prolapse requiring reconstruction.

Are there complications after urinary incontinence surgery?

Common complications include urethral stricture, recurrent UTIs, and difficulty urinating.

Do patients need follow-ups after treatment?

Regular follow-ups are essential to monitor progress and adjust treatment plans for optimal results.

• First follow-up at 6–8 weeks post-treatment, including a 72-hour voiding diary, 1-hour pad test, and incontinence questionnaire.
• Additional tests (urinalysis, ultrasound, urodynamics) may be ordered. Subsequent follow-ups every 3–6 months with similar assessments. Timing may vary based on condition changes.

Can urinary incontinence be completely cured?

Most patients can achieve significant improvement or full recovery with strict adherence to treatment. Studies show >90% efficacy for surgical treatment of female stress incontinence over 10 years.

Can urinary incontinence recur after treatment?

Yes.

Due to multiple potential causes, recurrence from different factors is possible. Regular follow-ups help detect and manage relapse early.

DIET & LIFESTYLE

What should urinary incontinence patients pay attention to in their diet?

• Reduce or avoid alcohol, caffeine, or acidic foods;
• Control fluid intake;
• Limit spicy and greasy foods;
• Maintain a balanced diet with plenty of fresh vegetables and fruits;
• Manage weight.

What should urinary incontinence patients pay attention to in daily life?

• Be mindful of skin-related issues caused by urine leakage, such as rashes, skin infections, or bedsores;

• Patients should dry themselves thoroughly with a towel, keep the skin dry, and avoid frequent washing;

• Apply barrier creams like petroleum jelly or cocoa butter to protect the skin from urine irritation;

• Maintain personal hygiene to prevent urinary tract infections;

• For patients with urge incontinence or nighttime incontinence, ensure easy access to the toilet by keeping pathways clear and using nightlights;

• Practice proper bladder and pelvic floor muscle training: contract the abdominal and perineal muscles, hold briefly, then relax. Repeat several times;

• Keep a detailed voiding diary.

What are the nursing considerations for urinary incontinence patients?

• Family members should provide emotional support and encourage patients to seek treatment.

• Set a positive example by maintaining confidence in recovery.

• Pay special attention to perineal skin care.

• For urge incontinence patients, arrange home layouts for easy bathroom access.

• Encourage proper bladder and pelvic floor muscle training, and assist with accurate voiding diary records.

• Promote healthy eating habits and weight management.

PREVENTION

Can Urinary Incontinence Be Prevented? How to Prevent Urinary Incontinence?

Urinary incontinence can be prevented. Preventive measures include:

• Controlling weight to avoid obesity;

• Quitting smoking and alcohol, avoiding bladder irritants such as caffeine, alcohol, and acidic foods;

• Consuming more fiber to prevent constipation;

• Performing pelvic floor muscle exercises;

• Some patients may opt for a cesarean section.