Urinary incontinence in women.

Urinary incontinence (UI) is a significant problem that affects the quality of life of millions of Americans. It is a common problem at all ages but is most prevalent in the elderly, especially among those living in an institution. Patients may not report incontinence to their primary care providers because of embarrassment or misconceptions regarding treatment. Most of those who eventually seek help do so only after an average of 4 years of enduring the symptoms and unhappiness this condition causes. Inadequate information and training have been major obstacles to the improved management of urinary incontinence. Yet this common and costly problem is eminently treatable in the community setting. It therefore behooves the health care professional to identify patients who might benefit from treatment. DEFINITION AND CLASSIFICATION OF UI Incontinence is the involuntary loss of urine. The lower urinary tract is composed of the urinary bladder as reservoir and the bladder outlet as sphincteric mechanism. Micturition is a complex series of finely tuned and integrated neuromuscular events that involve anatomic and neurologic mechanisms. Alterations in any of these components may result in dysfunctional voiding or UI. Urine leakage occurs when the pressure in the bladder exceeds that within the urethra. The main types of UI in women are stress incontinence, urge incontinence, and mixed incontinence. Stress UI (SUI) is involuntary leakage on effort or exertion or any sudden increase in abdominal pressure. This includes coughing, sneezing, sport activities, sudden changes of position, and the like. For those with severe incontinence, minimal exertion can cause leakage. SUI occurs as a result of the variable combination of intrinsic urethral sphincter muscle weakness and an anatomic defect in the urethral support, leading to insufficient closure pressure in the urethra during physical effort. The etiology is multifactorial and includes pregnancy, vaginal delivery, pelvic surgery,