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A systematic search of the medical literature was performed in
May 2007. The search, limited to human subjects and journals in
English language, included the National Guideline Clearinghouse, the
Cochrane database, PubMed, and UpToDate®. The
most recent national guidelines for urinary incontinence were created
in 1996 and are considered to be outdated. No revised national guidelines
were available at the time of publication.
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Urinary incontinence (UI) is the involuntary loss of urine1 and
results from several different etiologies that may or may not present
in combination with one another. Prevalence data for UI vary significantly
across the literature; however, evidence shows that UI increases
with age and is generally more prevalent in women.2
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Many individuals suffering from UI attempt to cope with the condition
without seeking medical intervention. This may be a result of the
social stigma associated with UI or the misconception that UI is
a normal part of aging.3 UI is a medical condition that
warrants evaluation and individualized management. Quality of life
in individuals suffering from UI is diminished when compared with
those without incontinence4; successful treatment of UI
is the ultimate goal of therapy whenever feasible.
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UI is classified on the basis of the duration and onset of symptoms.
Accurate diagnosis is essential to ensure that the most appropriate
treatment strategies are initiated. There are two general types of
UI: acute and persistent (or chronic). Acute UI is associated with
a new or recent medical condition that can be treated independently
from the resultant UI. Persistent UI is either not caused by a new
treatable medical condition or persists over a long period of time.
As described in the following sections, persistent UI is divided
into subtypes on the basis of etiology: urge urinary incontinence
(UUI), stress urinary incontinence (SUI), mixed UI, chronic retention
of urine (formerly overflow UI), and functional UI.
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Acute UI (or reversible UI) may present independently or in conjunction
with long-standing UI. There are numerous causes or contributing
factors for UI. A couple of useful mnemonics for identifying possible
reversible causes are listed in Table 32-15.
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Urge Urinary
Incontinence
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UUI results from an overactive bladder (OAB), a syndrome in which
the detrusor involuntarily contracts, either provoked or spontaneously,
causing a sudden “urge” ...