Urinary Incontinence: Pathophysiology and Comprehensive Management
Article
Urinary incontinence refers to the involuntary leaking of urine; there are multiple different types, including stress incontinence, overactive bladder, mixed incontinence, and overflow incontinence (2022). Stress incontinence is caused by a decrease in pelvic floor muscle. This type of incontinence can be exacerbated by movement or increased pressure, such as coughing or sneezing, which is common for many women (2022).
An overactive bladder is caused by an overwhelming urge to empty the bladder constantly, even if the bladder is not filled. Some people have both stress incontinence and an overactive bladder; the combination of the two causes the feeling of having to urinate without the muscle control to hold the urine, making it so urine can leak out frequently.
Some risk factors of incontinence include obesity, post-menopausal, smoking, history of hypertension or stroke, and a decrease in pelvis muscles (2022). Zeng et al. (2021) suggest a correlation between stress incontinence in women and obstetric and gynecologic history. History of pregnancy, obesity, and increased abdominal pressure can cause damage to pelvic muscles, leading to incontinence for some women (Zeng et al., 2021).
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Smoking is also a risk factor for damaged pelvic muscles because of the increased pressure coughing causes as well as the amount of collagen tissue (Zeng et al., 2021). It is not surprising the patient feels uneasy talking about her recent issues with the nurse practitioner. Many patients feel similarly and do not speak up about their incontinence because of embarrassment.
According to the Urology Care Foundation (2022), many patients do not speak to their providers about incontinence because they think it is a normal part of aging and there is nothing that can be done to help them. In this case, the NP should reassure the patient and develop a plan to reduce symptoms and improve the quality of life for the patient.
References
Urology Care Foundation. (2022). Urinary incontinence. Incontinence: Symptoms & Treatment – Urology Care Foundation. Retrieved October 10, 2022, from https://www.urologyhealth.org/urology-a-z/u/urinary-incontinence
Zhang, R. Q., Xia, M. C., Cui, F., Chen, J. W., Bian, X. D., Xie, H. J., & Shuang, W. B. (2021). Epidemiological survey of adult female stress urinary incontinence. BMC Women\’s Health, 21(1). https://doi.org/10.1186/s12905-021-01319-z
Response
Hi,
I appreciate the information you provided in your initial discussion regarding the pathophysiology that is associated with incontinence. I have a feeling that most healthcare providers do not understand the pathophysiology of incontinence as much as they understand its management. Therefore, it is an important topic to discuss as a DNP student. I agree with your perception of urinary incontinence by stating that it is involuntary leakage of urine (Harris & Riggs, 2022). Indeed, there are different types of urinary incontinence, which include stress incontinence, overactive bladder incontinence, overflow incontinence, and others.
Stress incontinence is associated with increased intraabdominal pressure or physical exertion such as sneezing, coughing, lifting, exercise, or jumping. The pathophysiology of this type of incontinence is strongly related to the weakness of the pelvic floor or a loss of the normal urethral vesicle angle (Harris & Riggs, 2022). Overactive bladder occurs as an overwhelming urge to urinate even when the bladder is not full. Patients are diagnosed with mixed urinary incontinence when they have both types of urinary continence.
While the pathophysiology of stress incontinence is a result of pelvic floor weakness, that of urge continence/overactive bladder is due to irritation or loss of neurologic control of bladder contractions (Wyndaele & Hashim, 2017). Urethral hypermobility and intrinsic sphincter deficiency are two pathophysiological pathways identified with stress urinary incontinence. Pathophysiology of urge incontinence is related to problems in bladder contraction due to loss of neurologic control of bladder contractions (Wyndaele & Hashim, 2017). The urothelium-based hypothesis and a myogenic hypothesis are two theories associated with bladder contraction problems.
To expand on the knowledge already provided in the initial discussion, urinary incontinence is a serious community health issue affecting about 40% of all adult women in the United States. More than 25 % of teenage female athletes suffer from continence (Harris & Riggs, 2022). About 90% of them have not disclosed incontinence information to their care providers.
The U.S. is spending more than $10 billion every year to treat urinary incontinence, especially the mixed type is a serious concern across age groups (Harris & Riggs, 2022). Treatment of incontinence should always start with the least invasive management. Behavioral methods include dietary changes, bladder retraining, Kegel exercise, and others. Similarly, pharmacological interventions are essential in improving incontinence symptoms. Some of the medications include oxybutynin, CA channel blockers, tricyclic antidepressants, and alpha-adrenergic (Harris & Riggs, 2022). Differential diagnoses include cystitis, multiple sclerosis, prostatitis, spinal cord, and others.
References
Harris, S., & Riggs, J. (2022). Mixed Urinary Incontinence. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK534234/#:~:text=The%20pathophysiology%20of%20stress%20incontinence,neurologic%20control%20of%20bladder%20contractions.
Wyndaele, M., & Hashim, H. (2017). Pathophysiology of urinary incontinence. Surgery (Oxford), 35(6), 287-292. http://dx.doi.org/10.1016/ j.mpsur.2017.03.002