Overactive bladder and storage lower urinary tract symptoms

What it is

Symptoms of urgency may also occur without urinary loss, which is known as overactive bladder. That is the line the table draws: the urgency is common to both, the leakage is not.

Urge incontinence itself is detrusor overactivity (uninhibited bladder contractions) caused by irritation within the bladder or loss of inhibitory neurologic control of bladder contractions.

The five types of chronic urinary incontinence

• Stress. 24 to 45 percent in women older than 30 years. Sphincter weakness (urethral sphincter and/or pelvic floor weakness). Loss of small amount of urine during physical activity or intra-abdominal pressure (coughing, sneezing, jumping, lifting, exercise); can occur with minimal activity, such as walking or rising from a chair. Patient usually can predict which activities will cause leakage. Etiology: childbirth and obesity in women; may occur after prostatectomy in men.
• Urge. 9 percent in women 40 to 44 years of age, 31 percent in women older than 75 years, 42 percent in men older than 75 years. Loss of urine preceded by a sudden and severe desire to pass urine; patient typically loses urine on the way to the toilet. Bladder contractions may also be stimulated by a change in body position, from supine to upright, or with sensory stimulation such as running water, hand washing, cold weather, arriving at the front door. Volume of urine loss is variable, ranging from minimal to flooding if entire bladder volume is emptied; frequency and nocturia are common. Etiology: bladder irritation caused by cystitis, prostatitis, atrophic vaginitis, bladder diverticuli, prior pelvic radiation therapy; loss of neurologic control caused by stroke, dementia, spinal cord injury, Parkinson disease.
• Mixed. 20 to 30 percent of patients with chronic incontinence. Combination of stress and urge incontinence. Involuntary leakage associated with symptoms of urgency; loss of urine with exertion, effort, sneezing, or coughing.
• Overflow, that is urinary retention. 5 percent of patients with chronic incontinence. Overdistention of the bladder caused by impaired detrusor contractility or bladder outlet obstruction; leads to urine leakage by overflow. Dribbling of urine, inability to empty bladder, urinary hesitancy, urine loss without a recognizable urge or sensation of fullness or pressure in lower abdomen. Does not usually occur unless bladder emptying is poor, with postvoid residual volumes > 200 to 300 mL. Etiology: anticholinergic medications, benign prostatic hyperplasia, pelvic organ prolapse, diabetes mellitus, multiple sclerosis, spinal cord injuries.
• Functional. Prevalence uncertain. Variable leakage of urine, usually caused by environmental or physical barriers to toileting; caused by nongenitourinary factors, such as cognitive or physical impairments that result in the patient's inability to void independently. Impaired physical function (immobility) and/or impaired cognition.