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Understanding Incontinence Better

Urinary incontinence (UI) [1] is the involuntary leakage of urine. It often remains undetected and undertreated. It is a common and embarrassing problem affecting millions in the world. The severity varies from occasional leaks when you cough or sneeze to having a sudden and strong desire to urinate that you might wet your pants while dashing to the toilet. Readers should be made aware that urinary incontinence is not a disease but a symptom due to personal habits, physical problems or underlying medical conditions.

Aetiology [1,2,3]

The different types of urinary incontinence, common causes, and clinical features are discussed in the table below:



Common Cause

Clinical Features

Stress UI

Involuntary loss of urine due to increased pressure on the bladder

Typical provoking events – sneezing, straining due to constipation, laughing


Occurs largely in women

Weakened pelvic floor muscles due to multiparity, obesity, chronic cough, straining of stool


Pelvic Organ Prolapse


Previous vaginal/bladder surgery

Frequent, small amounts of urine leakage

Typically follows a stressor

No irritative symptoms or nocturia (excessive urinating at night)

Normal bladder capacity

Urge UI

(overactive bladder)

Involuntary leakage associated with a sudden strong need to void, larger amount


Affects both males and females

Urinary tract infection

Upper motor neuron lesion


Parkinson’s Disease

Irritative voiding symptoms:

  • Urgency, frequency, nocturia
  • Moderate to large volumes of UI
  • Smaller bladder capacity

Often co-exist with stress UI – called mixed UI

Overflow UI

Involuntary leakage associated with loss of bladder muscle contractility and/or bladder outlet obstruction, resulting in incomplete emptying of the bladder and retention of urine


Largely affects male


Lower motor neuron lesion


Urethral Stricture

Pelvic Cancer

Faecal Impaction

Benign Prostatic Hyperplasia

(commonest cause in Male over the age of 60)


Obstructive voiding symptoms:

  • Hesitancy, straining to void
  • Intermittent reduced urine stream
  • Prolonged voiding
  • Post-voiding dribbling and sensation of bladder fullness

Functional UI

Involuntary leakage associated with cognitive, functional or mobility difficulties that impair the ability to use the toilet, but without failure of the bladder’s capacity for storage and emptying.

Dementia or cognitive repair





Continence improves when appropriate help is provided




Urinary incontinence does not increases the mortality rate however, if prolonged it can cause severe impact on other aspects of a patient’s life such as quality of life, sexual dysfunction, increased morbidity, and increased care giver burden.

Patients may be reluctant to initiate discussions about their incontinence and urinary symptoms due to embarrassment, lack of knowledge about treatment options, and/or fear of surgery.

If urinary incontinence affects your daily activities, don't hesitate to see your doctor. For most people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence.

A thorough evaluation by your doctor can help determine what's behind your incontinence.


1. Urinary incontinence Causes - Mayo Clinic [Internet]. Mayo Clinic. 2017 [cited 22 June 2017]. Available from:

2. Urinary incontinence in men [Internet]. 2017 [cited 22 June 2017]. Available from:

3. Evaluation of women with urinary incontinence [Internet]. 2017 [cited 22 June 2017]. Available from:

urinary incontinence, frequent urination, stress incontinence, urge incontinence, overflow incontinence, functional incontinence

About The Author
Dr. Devalagan Muthalagan holds an MBBS from IMU. Currently, he is serving as a House Officer at Hospital Taiping.

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