hi everyone we're talking about urinary incontinence in this lesson so we're going to talk about the different types of urinary incontinence the symptoms of each type we're also going to talk about how they're diagnosed and how they're treated so urinary incontinence is a loss of bladder control with involuntary urination or loss of urine now i mentioned that there are different types of urinary incontinence one type is known as stress incontinence another type is known as urge incontinence another type is mixed incontinence which is a mixture of both stress and urge incontinence the fourth type is overflow incontinence and a fifth type is known as functional incontinence so we're going to talk about each of these in more detail in the next upcoming slides including some of the risk factors for each of them and what actually happens with each type so what is the epidemiology of urinary incontinence in general more women are affected by urinary incontinence than men but as we will see certain types of urinary incontinence are more common in women and some types are more common in men but overall urinary incontinence in general more common in women and urinary incontinence in general is more prevalent in older people than in younger people and this will all tie in with the risk factors as to why these types of urinary incontinence occur now let's talk about the types of urinary incontinence in more detail along with the causes of each so again we look at stress incontinence first the causes of stress incontinence are as follows so stress incontinence is due to a weakening of muscles that support the pelvis and pelvic structures so these muscles can weaken over time so increasing age as a patient gets older this is a cause or risk factor for having stress incontinence another cause or risk factor for getting stress incontinence is vaginal delivery so vaginal delivery of a baby causes weakness and stretching of some of those supportive pelvic muscles which can lead to a decreased ability to actually control bladder emptying or voiding pelvic surgery is another risk factor another cause so you can imagine that if there is any surgery in the pelvic area some of the muscles could be damaged or weakened this will increase the likelihood of stress incontinence menopause is also another risk factor and smoking is a risk factor now let's talk about urge incontinence so urge incontinence is also known as an overactive bladder and ultimately it's due to detrucer overactivity so the the trucer muscles are responsible for allowing contraction of the bladder allowing proper urination and proper urinary control but with urge incontinence there is detrusor over activity the muscle the detrusor muscle is overactive so some of the causes for urge incontinence are as follows one and the main one here is idiopathic causes which means we don't know what the cause might be this occurs in roughly 90 percent of patients with urge incontinence a second cause of urge incontinence is detrusor muscle instability a third cause is central nervous system lesions so cns lesions you can think of spinal cord injuries so if there is a spinal cord injury there can be problems in neural control over the detrusor muscle so this can lead to detrusor over activity another common or more common cause of urge incontinence is benign prostatic hyperplasia which occurs in men so bph can be a risk factor for urge incontinence other types of obstruction like bladder neck obstruction can also lead to urge incontinence cystitis so especially chronic cystitis chronic inflammation the bladder can lead to an overactive bladder increasing age is also another risk factor and obesity is another risk factor for urge incontinence now let's talk about overflow incontinence so overflow urinary incontinence is caused by urinary retention and it is essentially the opposite of urge incontinence where there is impaired detrusor contractility so the causes of overflow incontinence are as follows benign prostatic hyperplasia is a very significant cause of overflow urinary incontinence so bph again occurring in men an enlarged prostate that essentially obstructs the outflow of urine and then the bladder can become stretched and stretched and this can lead to issues with the detrusor muscle impaired detrusor contractility we can also see it with diabetes other types of central nervous system lesions and multiple sclerosis so if there are certain pathologies that are affecting the ability to actually contract the detrusor muscle these can lead to overflow urinary incontinence and then there is functional urinary incontinence and essentially functional urinary incontinence is where a patient is not able to get to the bathroom in time perhaps they really need to use a washroom and we see this in older patients so some of the causes include environmental barriers to toileting and then other physical impairments if they're not able to walk or immobile this can also be another cause of functional urinary incontinence essentially functional urinary incontinence is where a patient really has to use the washroom but they can't they're not able to make it to the toilet and then they have a issue of voiding when they shouldn't but that's mostly because it can't get to the toilet now that we know the types of urinary incontinence and the risk factors and causes of urinary incontinence let's talk about the clinical features of each type so the first type we're going to talk about is stress incontinence now this is a very common type of urinary incontinence again it is involuntary urination or loss of urine but with regards to stress incontinence this involuntary loss of urine occurs in particular situations in those situations are when there is increased intra-abdominal pressure so what does that mean when there's increased pressure in your abdomen there can be some loss of urine again this is due to weakness of those pelvic muscles we talked about before there is decreased ability to control when the bladder releases urine especially when there's increased intra-abdominal pressures so some of these situations include coughing so coughing increases intra-abdominal pressure causing some loss of urine sneezing sneezing is another situation where we see some loss of urine lifting so any lifting or heavy lifting will increase the intra-abdominal pressures leading to some loss of urine laughing is another situation where there can be some loss of urine as well and exercising so these are all situations that can lead to loss of urine in stress incontinence this is what stress urinary incontinence is when there is some loss of urine during these types of situations now let's talk about urge incontinence so this is a different type of urinary incontinence as we will see in a moment so urge incontinence is when there's a loss of urine that occurs when there's a sudden urge to urinate so the patient goes throughout their day and all of a sudden they have a very strong urge to urinate and then there can be some loss of urine so it's a very different clinical presentation than stress incontinence so with urge incontinence there is urinary urgency and urge to urinate and then with urgent continence there's also an increased urinary frequency so patients will feel that they have to go to the washroom very quickly and very frequently and then with urgent continence there's also nocturia which means urinating at night so they will be awakened at night with a sudden urge to urinate as well and there can be some loss of urine in those situations so you can see that there's a very big difference between stress incontinence and urge incontinence now let's talk about overflow incontinence so overflow incontinence is when there is an involuntary urination loss of urine with a full bladder so this differs from the previous types of urinary incontinence we just talked about i didn't mention before but urge incontinence a patient may have an urge to urinate even when they don't have much fluid in their bladder so a very big difference here so overflow incontinence is when there's a loss of urine with a full bladder so with overflow incontinence there is a full bladder and patient feels they need to urinate but they can't there's difficulty urinating and then there's some urinary straining as well so there's difficulty starting urination and then there's difficulty continuing urination so this is where there is detrucer inactivity or a low activity of the detrusor muscle and then also with overflow incontinence there is a poor emptying of the bladder so this is considered a lazy bladder the bladder is not able to contract and release urine as well as it should and then there's mixed incontinence we mentioned this before it's a mixture of stress and urge incontinence features and then i won't mention the functional incontinence as this is something that occurs when a patient has a full bladder they feel like they need to use a washroom they try but there's some barrier they either have some physical immobility or there's some barrier in the environment and they're not able to make it on time and they have a loss of urine and that is what we would call functional urinary incontinence so now that we know the types of urinary incontinence and what happens with each of them how are each of these diagnosed and treated clinicians diagnose urinary incontinence often by clinical diagnosis so they get a detailed history from the patient they see the types of symptoms that the patient is describing and the patient has some of those risk factors we talked about that is enough to make the diagnosis but it's also important to check medications that could be causing some issues with urinary incontinence and it's also important to check your analysis for any signs of a uti or urinary tract infection and then blood urea nitrogen can also be measured as well now the treatment of urinary incontinence depends on the type of urinary incontinence with stress incontinence it's important to have lifestyle modification so fluid intake scheduling so drinking fluids at particular times and avoiding other times timed voids so ensuring that the bladder is empty so if there is a situation where there is laughter or sneezing or coughing there won't be as much loss of urine or no loss at all and then weight loss can also help weight loss can reduce intra-abdominal pressures so you can imagine if you have a larger abdomen you're going to have more pressure within the abdomen you're going to have increased intra-abdominal pressure which is going to make it easier to have stress incontinence now some other methods to treat stress incontinence are kegel exercises these are pelvic floor exercises if you want more information on kegel exercises please look this up online and pharmacological treatments are also available to treat stress incontinence in some situations and one example for stress incontinence is phenylpropalamine for the treatment of urge incontinence similar to lifestyle treatments for stress incontinence but the pharmacological treatments are different so some of the pharmacological treatments for an urge incontinence or an overactive bladder include derived feneson solophenicin oxybutenin and mirabegron so these are some of the pharmacological treatments that can be used to help with an overactive bladder with overflow incontinence because there's issues with voiding with either initiating or maintaining urinary output intermittent catheterization or induling catheter is one possible method to treat overflow incontinence if there is a obstruction that is identified obstruction relief is important and then some of the pharmacological treatments that are available for overflow incontinence include pterazycin and tamsilosin these help with reducing urinary retention and then with functional incontinence it's important to identify and alleviate the barriers to that patient getting to the toilet so as you can see each type of incontinence is different has a difficult different clinical presentation has a different set of risk factors and it has a different set of treatments stress incontinence again important for lifestyle kegel exercises and possibly some pharmacological treatment urge incontinence you're going to see more pharmacological treatments being used for this overactive bladder type of urinary incontinence overflow incontinence because there's some issues with urinary retention or actual issues with voiding itself sometimes catheters may be used and some other pharmacological treatments may be used so the alpha antagonists like terrazasen and tamsilosin and then functional incontinence important to identify and alleviate the barriers for an individual to actually get to the toilet so if you want to learn more about other types of urological and nephrological conditions please check out my playlist on those topics and if you haven't already 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