Understanding Urinary Incontinence in Adults

Angela Testa, MSN, AGPCNP-BC


Urol Nurs. 2015;35(2):82-86. 

In This Article

Classifications of Urinary Incontinence

There are five main types of UI, including stress, urgency, mixed, overflow, and transient and functional UI. Classification of UI is based on symptoms and underlying pathophysiology (Wieder, 2010). Treatment of UI is dependent on accurate diagnosis and classification. However, classifying the type of UI for elderly patients is difficult because it may be the result of multiple interacting causes. This complexity broadens the differential and opposes the classification of the incontinence into one specific category.

Stress Urinary Incontinence

Stress urinary incontinence (SUI) is defined as "the complaint of involuntary leakage on effort or exertion" resulting from increased intra-abdominal pressure (Abrams et al., 2002). This can arise from maneuvers such as coughing, sneezing, straining, lifting, bending, and exertion (Goode, Burgio, Richter, & Markland, 2010). Risk factors for SUI include history of vaginal delivery, pelvic surgery, radiation, trauma, obesity, advanced age, and menopause. Post operative prostatectomy complications, such as scar tissue formation or damage to urethral nerves or muscle, may contribute to SUI in men (Scemons, 2013).

Urgency Urinary Incontinence

Urgency should be suspected in the individual who presents with the sudden and imperative need to pass urine. The "complaint of involuntary leakage accompanied by or immediately preceded by urgency" is defined as urgency urinary incontinence (UUI) (Abrams et al., 2002). UUI has been attributed to detrusor over activity, commonly seen in patients with neurological problems, low bladder compliance, or as often the case, idiopathic in that no plausible cause can be detected (Nygaard, 2010; Scemons, 2013; Wieder, 2010).

Mixed Urinary Incontinence

The combination of UUI and SUI is mixed urinary incontinence. This type of UI is commonly found in middle-aged and older women as a result of fluctuating estrogen levels and consequent lower urethral muscle pressure (Gomelsky & Dmochowski, 2011; Scemons, 2013).

Overflow Urinary Incontinence

In overflow urinary incontinence, the bladder overfills, and urine leaks out due to pressure on the urinary sphincter (Buttaro et al., 2013; Wieder, 2010). More common in older men, overflow urinary incontinence can be attributed to benign prostatic hyperplasia (BPH), pelvic surgery, or as a side effect of medications (Scemons, 2013). Neurological conditions that contribute to UI in adults include multiple sclerosis, Parkinson's disease, cerebral palsy, and spinal cord injury (Harris et al., 2012). Patients may report incomplete bladder emptying, a weak or slow urinary stream, nocturia, post-void dribbling, and straining to expel urine (Scemons, 2013).

Transient and Functional Urinary Incontinence

Transient incontinence results from sources secondary to the urinary tract, including delirium, infection, medications, psychological problems, constipation, and any condition that increases either the blood pressure or blood osmolality (Buttaro et al., 2013; Wieder, 2012). A subcategory of transient urinary incontinence includes functional urinary incontinence (FUI). FUI defines "the state in which an individual experiences an involuntary unpredictable passage of urine" evidenced by the inability of the adult to reach the appropriate place to void in a given time. Risk factors include unavailability of a toileting facility and the inability to reach a toileting facility due to physical limitations. Older adults with cognitive impairment may recognize the need to void but may be unable to verbally express this need (Klopp, 2002).