Incontinence or the involuntary loss of urine is a common problem in both men and women. There are several types of incontinence, namely: stress incontinence, urge incontinence, total incontinence, and overflow incontinence. It is essential to establish the type of incontinence, as treatment is different for each type.

Stress incontinence: This involves leakage with coughing, sneezing, laughing, or stress-bearing activities. The degree of leakage can range from a small drop of urine when doing kickboxing to soaking one’s pad by simply sitting up. The risk factors for stress incontinence include: vaginal deliveries, trauma, obesity, activity level, smoking, chronic lung disease, pelvic surgery, and age. A physical exam is important to evaluate for anatomical abnormalities such as bladder drop. Several treatment options are available including non-surgical treatments such as pelvic floor strengthening, estrogen therapy, collagen injections, and/or surgery.

Urge incontinence: Urge incontinence is the sudden need to urinate and often occurs while trying to get to the bathroom. In a patient with urgency symptoms it is important to evaluate for secondary causes such as a bladder infection, enlarged prostate, bladder stones, and bladder cancer. Also patients with neurologic conditions such as Parkinson’s disease, multiple sclerosis, and strokes can have urge incontinence. Treatment includes medication, behavioral therapy, and/or surgery.

Overflow incontinence: Patients with overflow incontinence leak urine from an overfilled bladder. Improper bladder emptying can result from bladder outlet obstruction or bladder muscle weakness. Bladder obstruction can occur in men with enlarged prostates or very tight narrowings in the urethra called strictures. Bladder muscle weakness can be found in patients with diabetes mellitus, neuromuscular problems, spinal cord injuries, and those taking certain medications.

Total incontinence: Patients with total incontinence have constant leakage of urine resulting from abnormal connection to the bladder. A fistula, or an abnormal drainage tract from the bladder, can be caused by chronic inflammation, surgery, radiation, or malignancy. Prior to surgical correction, investigative studies and tests are needed to confirm the abnormal connection. Typically surgery is required to correct the fistula.

Urodynamics: Urodynamics involves placing a small catheter in the bladder after the patient has voided to first evaluate the amount of residual urine in the bladder. Normally, a patient should be able to empty the bladder. The bladder is then passively filled to examine normal bladder filling and to detect sudden bladder contractions. The catheter is then removed and the patient is asked to cough as the physician observes for leakage.

Urodynamics is typically used in situations where there is mixed incontinence, poor response to medical therapy, complex history, neurologic derangement, or sometimes prior to surgery. Urodynamics is not a single test but a combination of tests that are used to evaluate the function of the bladder. The evaluation of incontinence takes into consideration many factors including the patient’s function ability, symptoms, physical findings, laboratory tests, and urodynamics if needed. While urodynamics can add important information in evaluating patients with incontinence, the patient’s history of illness and physical examination are still the most critical parts of the evaluation.