Types of Urinary Incontinence: Stress, Urge, Mixed, Overflow, Reflex

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Types of Urinary Incontinence

There are a few different types and causes of urinary incontinence. The diagnosis and treatment for each type of incontinence is categorized by the type of problem and differences in symptoms that leads to the loss of urination control. These different types of urinary incontinence are listed below:  

Stress Urinary Incontinence (SUI)

Stress incontinence occurs when the urethral sphincter, the pelvic floor muscles, or both of these muscle structures have been weakened or damaged, and thus cannot dependably hold in urine. The word "stress" refers to the physical strain and muscular activity associated with leakage. 

"If urine leaks out when you jump, cough, laugh, run, walk, bend over, or do any physical exertion that increases abdominal pressure on the bladder, you may have stress incontinence.

The leakage occurs even though the bladder muscles are not contracting and you don't feel the urge to urinate."

A common misconception is that stress incontinence is based on emotionally distressing events, but this condition has nothing to do with emotion.  Usually only a small amount of urine leaks out and it is manageable using a sanitary napkin or disposable pad. In more severe cases, the pressure of physical stress on a full bladder overwhelms the body's ability to hold in urine, and the leakage has more volume. 

Urge Incontinence (UI) or Overactive Bladder (OAB)

Another common bladder problem is called Overactive Bladder (OAB), or Urgency Urinary Incontinence (UUI). People with OAB have an urgent, "gotta go" feeling that they can't control. This condition occurs in both men and women and involves an overwhelming urge to urinate immediately, frequently followed by loss of urine before you can reach a bathroom. Even if you never have an accident, urgency and urinary frequency can interfere with work and a social life because of the need to keep running to the bathroom.

"If you feel a strong urge to urinate even when your bladder isn't full, your incontinence might be related to overactive bladder, sometimes called urge incontinence."

The difference between stress urinary incontinence and overactive bladder is anatomical. Stress urinary incontinence is a urethral problem while urge incontinence is a bladder problem. With stress incontinence, the urethra cannot stop the sudden increase in pressure. With urge incontinence, the bladder spasms and squeezes urgently and uncontrollably. 

Mixed Incontinence

If you have symptoms of both overactive bladder and stress incontinence, you likely have mixed incontinence, a combination of both types. Mixed incontinence also occurs in men who have had prostate removal or surgery for an enlarged prostate, and in frail older people of either gender.

Overflow Incontinence

Overflow incontinence occurs when something blocks urine from flowing normally out of the bladder, as in the case of prostate enlargement that partially closes off the urethra. It can occur in both men and women if the bladder muscle becomes underactive (the opposite of an overactive bladder) meaning you don't feel an urge to urinate. The bladder may also spasm at random times, causing leakage. This condition is sometimes related to diabetes or cardiovascular disease.

"If your bladder never completely empties, you might experience urine leakage, with or without feeling a need to go. 

Eventually the bladder becomes overfilled, or distended, pulling the urethra open and allowing urine to leak out."

Men are much more frequently diagnosed with overflow incontinence than women because it is often caused by prostate-related conditions. In addition to enlarged prostate, other possible causes of urine blockage include tumors, bladder stones, or scar tissue. If a woman has a severe prolapse of her uterus or bladder (meaning that the organ has dropped out of its proper position), her urethra can become kinked like a bent garden hose, interfering with the flow of urine. Nerve damage (from injuries, childbirth, past surgeries, or diseases such as diabetes, multiple sclerosis, or shingles) and aging often prevent the bladder muscle from contracting normally. Medications that prevent bladder muscle contraction or that make you unaware of the urge to urinate can also result in overflow incontinence.

Functional Incontinence

If your urinary tract is functioning properly but other illnesses or disabilities are preventing you from staying dry, you might have what is known as functional incontinence. Medications, dementia, or mental illness can decrease awareness of the need to find a toilet. Even if your urinary system is fine, it can be extremely difficult for you to avoid accidents if you have trouble getting to a toilet. This includes problems as diverse as having arthritis, being hospitalized or restrained, or having a toilet located too far away.

"If an illness rendered you unaware or unconcerned about the need to find a toilet, you would become incontinent.

This problem can affect anyone with a condition that makes it excessively difficult to move to the bathroom and undress in time."

If a medication (such as a diuretic used to treat high blood pressure or heart failure) causes you to produce abnormally large amounts of urine, you could develop incontinence that requires a change in treatment. If you make most of your urine at night, the result might be nocturnal incontinence, or bedwetting. To remedy this, using a protective mattress pad or using disposable bed pads on your bed may ease your worry and contain any leakage during the night, and prevents a load of soiled laundry in the morning.

Reflex incontinence

Reflex incontinence occurs when the bladder muscle contracts and urine leaks (often in large amounts) without any warning or urge. This can happen as a result of damage to the nerves that normally warn the brain that the bladder is filling.

"Reflex incontinence usually appears in people with serious neurological impairment from multiple sclerosis, spinal cord injury, other injuries, or damage from surgery or radiation treatment."

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