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Source: Rovner ES, Wyman J, Lam S. Urinary incontinence. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. Accessed May 10, 2017.


  • Involuntary leakage of urine.


  • Urinary incontinence (UI) occurs as a result of overfunctioning or underfunctioning of urethra, bladder, or both.

    • Stress UI (SUI) results from urethral underactivity and occurs during periods of physical activity (eg, exercise, coughing, and sneezing)

    • Urge UI (UUI) results from bladder overactivity.

      • Associated with increased urinary frequency and urgency, with or without urge incontinence.

    • Overflow incontinence results from urethral overactivity and/or bladder underactivity.

    • Mixed incontinence results from bladder overactivity and urethral underactivity.

  • Functional incontinence linked to primary disease process such as dementia or cognitive or mobility deficits.

  • Many medications can aggravate voiding dysfunction and UI (Table 1).

TABLE 1.Medications That Influence Lower Urinary Tract Function


  • Urethral sphincter maintains adequate resistance to flow of urine from bladder until voluntary voiding initiated.

  • Normal bladder emptying occurs with opening of urethra concomitant with volitional bladder contraction.

    • Acetylcholine activates postsynaptic muscarinic receptors that mediate both volitional and involuntary contractions of bladder.

      • M3 receptors responsible for both emptying contraction of normal micturition and involuntary bladder contractions, which can result in UI.

      • Most pharmacologic antimuscarinic therapy is anti-M3 based.


  • True prevalence difficult to determine.

  • Peak incidence in women at the time of menopause.

  • Chronic UI is one of the most common reasons cited for institutionalization of the elderly in the US, and the condition is frequently encountered in the nursing home setting.

  • Twice as common in women as in men.



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