Urinary incontinence

Disease Description (Causes and Symptoms)

• Definition: Urinary incontinence is the leakage of urine involuntarily, regardless of a person’s intention. According to the form of symptoms, it is classified as stress incontinence (urine leakage when coughing, sneezing, or exercising), urge incontinence (being unable to hold urine accompanied by a sudden urge to urinate), mixed incontinence, overflow incontinence (urine flowing out when the bladder is overfilled), functional incontinence (urination problems caused by cognitive or behavioral problems), and true incontinence (structural abnormalities of the bladder or urethra, such as a vesicovaginal fistula).
• Main causes and pathophysiology:
  • Weakening of the pelvic floor muscles or damage to supporting structures (childbirth, pelvic surgery) → reduced urethral support → stress incontinence
  • Involuntary bladder contractions (overactive bladder, neurological lesions) → urge incontinence
  • Bladder emptying obstruction (benign prostatic hyperplasia, urethral obstruction) or reduced bladder contractility → overflow incontinence
  • Fistula between the ureter, bladder, and vagina (after surgery, childbirth, or radiation) → true incontinence
  • Impaired control caused by central or peripheral nervous system diseases (spinal cord injury, stroke, diabetic neuropathy)
• Main symptoms: frequent urination, nocturia, urinary urgency, urine leakage (with certain postures or activities), a sensation of incomplete bladder emptying after urination, skin irritation and rash, discomfort, and limitations in social activities

Treatment Methods

• General principles: A stepwise approach (non-surgical → medication → procedures/surgery) is used according to the type and severity of incontinence and the patient’s overall condition and preferences.
• Non-surgical treatment (first-line recommendation)
  • Lifestyle modification: weight loss (if obese), adjustment of caffeine, alcohol, and excessive fluid intake, and regular toilet habits
  • Bladder training (lengthening the intervals between urination), improving access to the toilet, and keeping a voiding diary
  • Pelvic floor muscle strengthening exercises (Kegel exercises): performed regularly with set numbers, repetitions, and durations (several months may be necessary)
  • Biofeedback, electrical stimulation, and pelvic support devices (pessaries for women), among others
• Medication treatment
  • Urge incontinence/overactive bladder: anticholinergics (oxybutynin, tolterodine, solifenacin, etc.) and beta-3 agonists (mirabegron)
    • Caution: Anticholinergics may cause dry mouth, constipation, and cognitive decline (in older adults). Mirabegron may increase blood pressure.
  • Overflow incontinence (with bladder outlet obstruction): alpha-blockers (when benign prostatic hyperplasia is present in men); cholinergic agonists (bethanechol) are used rarely
  • There are limited established drug treatments for stress urinary incontinence; urethral bulking agent injections (fillers) may be used in some cases
• Minimally invasive procedures/procedures
  • Stress urinary incontinence (women): midurethral sling (midurethral sling, TVT/TOT) and urethral bulking agents
    • Complications: exposure/infection of the foreign material (mesh), pain, and voiding dysfunction
  • Urge incontinence: intravesical botulinum toxin injection (temporary effect), neuromodulation (sacral nerve stimulation, SNS), and percutaneous tibial nerve stimulation (PTNS)
  • Male incontinence (after prostatectomy): sling surgery and artificial urinary sphincter (AUS) implantation
  • True incontinence: structural lesions such as fistulas are corrected surgically
  • Overflow incontinence (severe bladder outlet obstruction): prostate decompression surgery, intermittent self-catheterization, or catheter insertion
• Complications and precautions
  • Before treatment: infection (urinary tract infection) must be identified and treated
  • Medication side effects: anticholinergics (dry mouth, constipation, cognitive decline), mirabegron (risk of hypertension), and local injections (injury to the urethra or bladder)
  • Surgery-related: mesh exposure/infection, voiding dysfunction, pain, and possible recurrence
  • Skin and psychological effects: skin damage from repeated leakage, sleep disturbance, depression, and social withdrawal

Outpatient Visit Checklist (Including Preparation and Sample Questions)

• Items and records to prepare
  • A list of all medications currently being taken (including prescription drugs, OTC medications, and supplements), with doses and times of administration
  • History of previous surgeries (especially pelvic or prostate surgery), childbirth history, and history of radiation therapy
  • Recent urinalysis, uroflowmetry, post-void residual urine volume, and urodynamic test results (if available)
  • A 2–3-day voiding diary (recording urination times, voided volumes, leakage times, and activity at the time)
  • Changes in the weight of worn pads (if pad test results are available) or frequency of leakage
  • Underlying conditions (diabetes, neurological diseases, etc.) and allergies
• Tests expected at the outpatient visit
  • Urinalysis (to check for infection and hematuria), review of the voiding diary, and physical examination (pelvic and rectal examination)
  • Uroflowmetry and measurement of post-void residual urine; if necessary, urodynamic testing and imaging (ultrasound)
• Matters that should be mentioned at the outpatient visit (examples)
  • When the leakage began and its pattern (when it occurs and during which activities)
  • The impact of symptoms on daily life (sleep, going out, sexual activity, etc.)
  • Medications for which side effects are a concern (e.g., concern about anticholinergic side effects in someone with a history of cognitive impairment)

Examples of General Questions to Ask the Doctor

• "What type of urinary incontinence does this symptom appear to be, and what treatment is recommended for it?"
• "How often and for how long should I undergo the recommended non-surgical treatment before seeing an effect?"
• "What are the main side effects of the medication you plan to prescribe, and what special precautions are needed for older adults or people with cardiovascular disease?"
• "If surgery is recommended, what are the expected benefits and risks, including recurrence and complications?"

Examples of Condition-Specific Questions

• Women (with a history of childbirth or pelvic surgery): "If pelvic floor muscle exercises do not improve my symptoms, when would sling surgery become necessary, and what is the expected recovery and likelihood of complications after surgery?"
• Men (urinary incontinence after prostate surgery): "My urinary incontinence has continued for more than six months after prostatectomy. What degree of improvement can be expected with conservative treatment, and what are the indications for an artificial urinary sphincter (AUS)?"

If you need additional information (e.g., regarding a specific age group, drug interactions, or surgical details), please let us know, and we will organize that information in greater detail.