Types

Mixed incontinence - Mixed incontinence is usually a 60%-40% combination of Stress incontinence and Urge incontinence. It is most common in older women and may occur at different times or under different circumstances.

Since the causes of mixed stress and urge incontinence may or may not be the same, each aspect of this disorder should be evaluated separately by a physician.

Overflow Incontinence - People with overflow incontinence do not feel the urge to urinate. The bladder never empties normally and remains at least partially full; small amounts of urine are leaked on a nearly continuous basis. Weak bladder muscles -- caused by nerve damage from diabetes or other diseases -- or a blocked urethra can be responsible for overflow incontinence.

• Feeling as though the bladder is never completely empty
• Feeling the urge to urinate, but not being able to
• Passing a dribbling stream of urine, even after spending a long time at the toilet
• Frequently getting up at night to urinate

Stress Incontinence - People with stress incontinence lose urine involuntarily while doing certain physical activities that put pressure on the abdomen (lower part of the body between the ribs and hips). These include:

• Coughing, laughing or sneezing
• Lifting
• Walking or performing other forms of exercise
• Moving to get up from a chair or out of bed
• It is often necessary to use the bathroom often to avoid accidental urination.

It is believed that stress incontinence occurs when abdominal pressure upon the bladder is not balanced by equal pressure upon the urethra. This occurs when the bladder neck and urethra move down and bulge (herniate) through weakened structures within the pelvis. Herniation causes the angle of the urethra to change, which can cause the urethra to remain open. If the urethra is not pressed shut, urine can leak out.

Many urologists classify stress incontinence by a three-category system:

Type I is stress incontinence in which the bladder neck and urethra are open and slightly hypermobile (too moveable), and the urethra descends (moves down) less than 2 cm during stress (that is, the angle of the urethra is nearly unchanged). Type I patients also have little or no sign of cystocele.

Type II refers to stress incontinence in which the bladder neck and urethra are closed and very hypermobile, and the urethra descends more than 2 cm during stress that is, the angle of the urethra is increased. Type II patients also may have cystocele; if the cystocele is inside the vagina, the classification is Type IIA; if the cystocele is outside the vagina, the classification is Type IIB.

Type III, or intrinsic sphincter deficiency, refers to severe stress incontinence in which urethral position and support are not factors, but the urethral sphincter is very weak. Type III patients often have undergone a previous, failed surgical procedure.

Urge Incontinence - People with urge incontinence cannot control the sudden urge to urinate and their bladders will contract to squeeze out urine whenever full. A large amount of urine may be released in urge incontinence, as the bladder may empty. Urge incontinence may occur after a sudden change in position or activity.

They may need to go to the bathroom as frequently as every 2 hours. Bed-wetting is common. They may leak urine when they:

• Cannot reach a bathroom in enough time to avoid an accident
• Hear or touch running water
• Drink even a small amount of liquid

This type of incontinence is common among healthy people, but it may be linked to other disorders. For example, some women develop urge incontinence because of infections that irritate or produce muscle spasms in the bladder or urethra. Other people may experience urge incontinence because of illnesses that affect the central nervous system, such as stroke, spinal cord injury, dementia, Parkinson's disease, multiple sclerosis, and Alzheimer's disease. Constipation that results in stool impaction also can cause urge incontinence.