A 46-year-old P3003 presents to your office with a chief complaint of leakage of urine. She reports that she leaks when she coughs or sneezes. She is otherwise healthy, does not smoke, and takes no medications. Her history is significant for three vaginal deliveries.
If this woman were 78-year-old, what would be the most likely cause of urinary incontinence?A. Anatomic stress urinary incontinence
SUI is the involuntary loss of urine when intravesical pressure exceeds the maximum urethral pressure in the absence of detrusor activity. It is often brought on by laughing, coughing, or sneezing. This incidence is highest in women between the ages of 45 and 50. SUI may be caused by urethral hypermobility or intrinsic sphincter deficiency (ISD). The other major cause of incontinence is urge incontinence. With urge incontinence, the bladder leaks urine due to involuntary, uninhibited detrusor contractions. The incidence of urge incontinence increases with age. Other causes of urinary incontinence are less common and include overflow incontinence secondary to urinary retention, congenital abnormalities, infections, fistulas, and urethral diverticula. Urethral diverticula classically present with dribbling incontinence after voiding. Functional incontinence occurs when a patient cannot reach the toilet in time due to physical, cognitive, or psychological limitations.
In the elderly population there are also many transient causes of incontinence that the physician should consider. These include dementia, medications (especially α-adrenergic blockers), decreased patient mobility, endocrine abnormalities (hypercalcemia, hypothyroidism), stool impaction, and UTIs.