Urinary Incontinence

Urinary incontinence is involuntary urine leakage, but it is not one disease with one treatment. The pattern immediately before leakage usually identifies the mechanism: pressure-related leakage suggests stress incontinence; a compelling urge followed by leakage suggests urgency incontinence; continuous dribbling with poor emptying suggests overflow; and failure to reach or use the toilet despite an otherwise intact lower urinary tract suggests functional incontinence. Stress and urgency features may coexist as mixed incontinence. A patient who leaks while coughing needs a different assessment from a patient who suddenly cannot defer urination, even if both use several pads each day. Ask what the bladder was doing, what the patient was doing, and whether emptying was complete. That sequence prevents the common error of treating every form of leakage as overactive bladder. Incontinence becomes more common with age, pregnancy and vaginal birth, menopause, obesity, diabetes, smoking, and neurologic disease, but it is not an inevitable or untreatable part of ageing. The clinical goal is to identify the dominant mechanism, measure its effect on daily life, exclude infection, hematuria, retention, and neurologic disease, and...