There are several kinds of urinary incontinence (UI), a term that refers to the involuntary excretion of urine at the wrong time, in the wrong place. As the Canadian Continence Foundation points out, "incontinence is not a disease. Incontinence is a symptom of something else going on in the body and should be discussed with a healthcare professional."
The most frequent forms of UI are stress, overflow and urge incontinence, though urge incontinence may be seen in combination with other types.
- Stress urinary incontinence, which affects predominantly women, refers to urine loss when you exert a force on the bladder. Almost anything can do it: a cough or a sneeze, a laugh, exercise, picking up a bag of heavy groceries – anything that causes a bearing-down sensation.
The root of the problem is a loss of pelvic floor support due to childbirth, obesity, age or congenital weakness. The neck of the bladder falls below the pelvic floor, which is a sling of muscles that holds the uterus, bladder, bowel and other organs in place. If the bladder falls below that floor, the force vectors that usually operate to close it do the opposite: They kick the door open
Urge incontinence is associated with an irresistible urge to void, such that the person can’t get to the toilet in time, and (generally) the whole bladder empties. There is an urge to void constantly, yet there’s nothing there. There are a number of causes – even poor voiding habits learned as a child. As Cheryle B. Gartley writes in Managing Incontinence, "the embarrassed sufferer leaves a trail to the bathroom or a puddle on the floor. The condition is especially aggravating because the urge to void occurs so soon after the bladder was emptied."
Mixed urinary incontinence refers to a patient having a combination of both stress and urge UI.
Overflow incontinence refers to leakage of small amounts of urine without the urge to void, or the inability to urinate normal volumes. Women sometimes suffer overflow incontinence because of excessive narrowing of the urethra. Because they can’t empty the bladder, they’re carrying excess urine at all times, and the bladder has to get some of it out, which it does by "overflowing."
Total incontinence is exactly that – a complete absence of control, either involving continuous leakage or periodic uncontrolled emptying of the bladder.
Enuresis (or nocturnal enuresis) is the term that refers both to bedwetting in children who are theoretically old enough to be toilet-trained, and to adults who experience loss of bladder control at night.
Nocturnia is the frequent need to get up to void during the course of the night, a problem that often affects men with prostate difficulties.
Following are a few other terms you may hear your doctor use:
- Decreased bladder compliance: A failure to store urine in the bladder caused by a loss of bladder wall elasticity and of bladder accommodation. This condition may result from radiation cystitis or from inflammatory bladder conditions, such as chemical cystitis, interstitial cystitis and certain neurologic bladder disorders.
- Detrusor instability: An involuntary detrusor contraction that’s not associated with any neurologic disorders. (The detrusor is a general term for any part of the body that "pushes down." Here the detrusor is a smooth muscle in the wall of the urinary bladder that contracts the bladder and expels the urine.)
- Involuntary detrusor contraction: A cause of UI that results from uncontrolled contractions of the detrusor.
- Intrinsic sphincter deficiency (ISD): A cause of stress UI in which the urethral sphincter is unable to contract and generate sufficient resistance in the bladder. ISD may be due to congenital sphincter weakness, or it may develop in the wake of a prostatectomy (radical prostate surgery), trauma or radiation therapy.