The worldwide numbers of stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) were projected to affect 167 million (prevalence of 3.3%) and 60 million people (prevalence of 1.21%), respectively by 2018 (Irwin et al, 2011). Urinary incontinence is a major health issue, and the total direct and indirect cost in the United States alone was estimated at $19.5 billion in 2000, of which 75% is designated for the management of women with this condition. Incontinence also results in psychological and medical morbidity, significantly impacting health-related quality of life in a manner similar to other chronic medical conditions including osteoporosis, chronic obstructive pulmonary disease, and stroke. Overall prevalence of female incontinence is reported at 38%, increasing with age from 20–30% during young adult life to almost 50% in the elderly (Anger et al, 2006; Hawkins et al, 2010). The prevalence of stress incontinence peaks in the fifth decade of life, and thereafter the prevalence of mixed and urgency incontinence continues to increase. Several studies conducted in the United States show that stress urinary incontinence is more common in white women than in African-American or Asian-American women (Thom et al, 2006). Advances in the understanding of pathophysiology, as well as development of novel pharmacotherapy and surgical techniques for stress, mixed, and urge incontinence (UI), have redefined contemporary care of this patient group.
The International Continence Society (ICS) and the International Urogynecological Association (IUGA) have proposed standard terminology to be used to describe symptoms, signs, conditions, and urodynamic findings, as well as treatment (Abrams et al, 2003; Haylen et al, 2010). They define the symptom of urinary incontinence as “the complaint of any involuntary loss/leakage of urine.” It is also recommended, when describing incontinence, to specify relevant factors such as type, severity, precipitating factors, social impact, effect on hygiene and quality of life, measures used to contain the leakage, and whether the individual experiencing incontinence desires help.
Incontinence can be transient or chronic. Transient incontinence may occur after vaginal childbirth or during an acute lower urinary tract infection and usually resolves spontaneously. Chronic incontinence can result from a multitude of causes and is often persistent and progressive. From a functional and anatomic perspective, it is intuitive to consider the lower urinary tract as a two-part system: the urinary bladder as a reservoir and the bladder outlet as a sphincteric mechanism. Incontinence occurs when either part or both malfunction. Several common types of incontinence are discussed herein: stress urinary incontinence (SUI), urgency urinary incontinence, mixed urinary incontinence (MUI), neuropathic incontinence, and overflow incontinence (OI).
A stepwise management algorithm has been recommended for the management of male and female incontinence by the scientific committee of the 4th International Consultation on Incontinence (Abrams et al, 2010). In principle, the committee recommends an initial management and a specialized management algorithm for all types of incontinence. In ...