Types of urinary incontinence
Urinary incontinence is classified into the following categories:
- Stress urinary incontinence (SUI) : Leakage of urine during physical activity, sneezing, or coughing.
- Urge urinary incontinence (UUI) : Leakage of urine due to a sudden, urgent need to urinate.
- Mixed urinary incontinence (MUI) : Combination of SUI and IUI.
- Total or continuous urinary incontinence : Constant leakage.
- Overflow incontinence : Inability to completely empty the bladder, causing overflow.
- Functional incontinence : Linked to physical or psychiatric conditions.
- Post-micturition leakage : Leakage after urination.
Causes and evaluation of urinary incontinence
A proper evaluation by a healthcare professional is crucial to understanding the cause of urinary incontinence. This evaluation includes:
- Medical history : A detailed questionnaire about urination habits.
- Physical examination : General, abdominal, pelvic and neurological examination depending on symptoms.
- Specialized tests : These may include urinalysis, voiding diaries, and urodynamic studies.
It is essential to rule out underlying conditions such as vaginal atrophy, recurrent urinary tract infections, bladder stones, fistulas or even cancer, which could be contributing to incontinence.
Stress urinary incontinence (SUI)
Stress urinary incontinence (SUI), which affects 50% of patients with urinary incontinence in Canada, is defined as urinary leakage during physical activity, sneezing or coughing.
Risk factors for SUI include:
- Vaginal pregnancies and births.
- Use of forceps or vacuum extraction during childbirth.
- Large babies and prolonged labor.
- Episiotomy during childbirth.
- Overweight.
- Post-menopause.
- Chronic cough (due to smoking, for example).
Urge urinary incontinence (UUI)
Urge urinary incontinence affects 14% of patients and is characterized by a sudden, intense urge to urinate, resulting in leakage.
Mixed urinary incontinence (MUI)
Mixed urinary incontinence is a combination of SUI and IUI, affecting 32% of patients. Treatment strategies may vary depending on the dominant symptom type.
Assessment of urinary incontinence
The evaluation process includes several key steps:
- Medical History : A complete review of the patient’s systems, social and medical history, and habits as they relate to urination.
- Physical examination : Includes mental status, mobility, abdominal palpation, pelvic examination (in women), neurological examination if necessary, and digital rectal examination in men.
- Investigations : These may include:
- Urinalysis and urine flow tests.
- 3-day urination diary to track urinary habits.
- Validated questionnaires such as the International Consultation on Incontinence Questionnaire.
- Uroflowmetry, measurement of post-void residual volume.
- Cystoscopy or urodynamic studies in complex cases.
Treatment of stress urinary incontinence in women
There are several treatment options for women with stress urinary incontinence:
- Lifestyle changes :
- Reduce caffeine consumption.
- Losing weight when obese.
- Control constipation to reduce pressure on the bladder.
- Managing fluid intake in people who drink too much.
- Quitting smoking to control chronic cough.
- Establish voiding schedules to manage bladder capacity.
- Pelvic floor rehabilitation (PFMT) :
- Intensive pelvic floor rehabilitation is the first line of treatment for SUI (grade A recommendation).
- Vaginal cones can also be used but may cause discomfort.
- Pessaries may be considered as part of treatment.
Behavioral therapies may improve symptoms in the short term (up to 3 months), but long-term benefits (12 months) are not always sustained.
Non-surgical treatments for stress urinary incontinence
For mild forms of stress urinary incontinence, non-invasive options include:
- High-Intensity Focused Electromagnetic (HIFEM) Chair : Devices like the EMSELLA Chair or Libby Chair stimulate the pelvic floor muscles to reduce leakage.
- EmpowerRF by InMode : A multifunctional platform offering wellness therapies.
- Morpheus V8 : Uses bipolar radiofrequency technology to improve symptoms of vaginal laxity and light incontinence.
- VTone : Provides intravaginal electrical muscle stimulation to retrain pelvic floor muscles.
- Plus90 (called Votiva in the US): Improves blood circulation and helps with genitourinary syndrome of menopause (GUMS).
- Plasma injections (platelet-rich plasma): Still experimental, they show positive results in small studies.
Surgical treatment options for stress urinary incontinence
In more severe cases of SUI, surgical interventions may be recommended:
- Retropubic suspension.
- Bladder neck slings or synthetic suburethral sling (MUS) (grade A recommendation).
- For intrinsic urethral sphincter deficiency, bulking agents or an artificial urinary sphincter may be considered.
