The International Continence Society (ICS) defines urinary incontinence as any involuntary leakage of urine, that is, when it is not (always) possible for patients to control the time and place of urination. Furthermore, the ICS differentiates several forms as outlined below.
Overactive bladder (OAB) and urge urinary incontinence – symptoms and classification
Urinary incontinence is still a largely taboo subject in our society. The ability to control the bladder is a milestone in childhood development. Adults who no longer fully have this control often isolate themselves out of feelings of shame, ceasing to pursue their usual activities such as trips to the theatre, sporting activities or travel.
Patients have plenty of company
In Germany alone, it is estimated that 5-6 million men and women are affected by urinary incontinence:
- 13% of all women and 5% of all men
- 19% of women over 60 years old and 10% of men over 60 years old
- nearly 30% of the over-80s across both sexes
In addition, experts suspect that there are a large number of unreported cases due to many patients shying away from discussing this problem with their doctor, either because of embarrassment or because they believe that urinary incontinence is a normal feature of old age. Moreover, urinary incontinence is not only underreported but also undertreated, because many physicians are not yet fully aware of the latest treatment options available.
Forms of urinary incontinence and their symptoms
Urinary incontinence can have different causes and it is therefore classified into various forms. Different forms of urinary incontinence necessitate different treatment approaches.
These forms of urinary incontinence include:
Overactive bladder (OAB)/urge urinary incontinence
Overactive bladder/urge urinary incontinence is characterised by the following symptoms:
- A sudden, very strong urge to urinate that cannot be suppressed, which may be associated with the leakage of urine ("OAB wet"), but also can manifest without leakage of urine ("OAB dry").
- Small voided volumes in many cases, due to frequent urination during the day.
- Frequent urination at night.
For many patients, the episodes of a compulsive urge to urinate that they experience interfere greatly with their daily routine.
Urge urinary incontinence is a disorder of bladder storage. The bladder muscle, which is not under voluntary control of the central nervous system, contracts when the bladder contains only a small volume. The resulting intense urge to urinate can cause involuntary leakage of urine.
Stress incontinence is caused by weakness of the pelvic floor musculature, sphincter muscle and connective tissue. Involuntary passage of urine occurs with sneezing, laughing, coughing or running without a previous urge to urinate. Overweight women or men, women who have had multiple births, elderly people or men who have had prostate surgery are most often affected by this form of incontinence.
In mixed incontinence, the symptoms of both stress and OAB/urge urinary incontinence are present to a variable degree.
Incontinence due to neurogenic detrusor overactivity
Neurogenic detrusor overactivity results from damage to the nervous system due to disease, injuries or congenital malformations. Injuries with traumatic damage to the spinal cord are the main cause of these acquired disorders. The damage to the nervous system interferes with the interplay between the nerves and organs involved in urine storage and emptying. Patients no longer have control over bladder emptying and may not feel the urge to urinate either.
Overflow incontinence is also called incontinence due to chronic urinary retention. It is characterised by dribbling without the urge to urinate. The causes can include problems with bladder emptying, outflow disorders (for example, resulting from benign prostate enlargement or urethral injury) or underactivity of the bladder muscle (such as in neurological diseases). Although the bladder is filled, the patient cannot empty the bladder completely by urination and residual urine remains in the bladder.
Extraurethral incontinence is characterised by involuntary passage of urine through channels other than the urethra. These can be congenital or may be acquired due to injury (for example, bladder fistula). The storage function and sphincter mechanism of the bladder are not affected