Urinary incontinence is one of the most common urinary tract problems, affecting 17 million women in the United States. While it is not a serious medical problem, it does significantly affect quality of life and can cause depression, embarrassment, and alteration in lifestyles and activities in many women. The evaluation of urinary incontinence in women 1st involves classification of the type of incontinence. The three types of incontinence are 1) stress urinary incontinence, defined as a sudden loss of urine with a force exerted on the bladder, such as coughing, laughing, lifting or exercise; 2) urgency incontinence, which is defined as incontinence preceded by an uncontrollable urge to urinate; and 3) overflow incontinence, defined as leaking of urine through the urethra from a chronically full bladder that does not empty appropriately.

A careful history will give an indication of the type of incontinence. We ask the patient to describe the typical situation during which they experience the incontinence.

Stress incontinence would occur with some sort of physical activity or exertion that increases intraabdominal pressure. The patient typically would not have incontinence at rest or at nighttime, but they may have incontinence during sexual intercourse.

Urgency incontinence is preceded by an urge to void that is uncontrollable and usually associated with urinary frequency. This type of patient may have incontinence when at rest or they may suffer from nocturia.

Overflow incontinence, usually is associated with some recognizable comorbid condition, such as diabetes that causes a sensory neurogenic bladder, a first episode of herpes vaginalis, some sort of spinal cord pathology, such as a ruptured lumbar disk or, possibly, multiple sclerosis, etc.

The next step in evaluation is gauge the severity of the problem. We ask the patient how many days they leak per week and the number of pads required per day. Physical examination always includes a urinalysis and a check of the postvoid residual urine volume, usually a urodynamic evaluation to check the neurologic function of the bladder, a pelvic examination to look for cystoceles, and a cystoscopy to check for urethral or bladder pathology.

Treatment is directed by the findings of the evaluation. For stress urinary incontinence, bladder suspension is by far the most successful therapy. This is usually accomplished by a pubovaginal sling.

Urgency incontinence is treated by anticholinergic therapy to relax bladder contractions and treatment of underlying pathology, such as urinary tract infection, etc.

Overflow incontinence is treated by correcting the underlying condition, if possible, such as controlling diabetes, repair of a herniated disk, timed voiding, etc. Often it is also necessary to start the patient on an intermittent self-catheterization program every six to eight hours to keep the bladder empty and this will usually control the incontinence.

Incontinence, while often not a serious medical condition, causes significant inconvenience and embarrassment for patients. With proper evaluation and treatment, it can be cured or improved.