CLASSIFICATION OF INCONTINENCE
Incontinence is classified by both causes and
symptoms. The two most common types are called urge incontinence and
stress incontinence. Urge incontinence is primarily bladder "misbehavior,"
and as such is characterized by spontaneous and uncontrolled urine
leakage often accompanied by the overwhelming sensation of needing
to void. This condition is also referred to as bladder instability
or overactive bladder. Many people with this condition also have difficulty
with bowel control and report frequent bowel movements or difficulties
The causes of urge incontinence are not clearly known. It is likely
that changes in the nerves controlling the bladder or the bladder
muscle itself play important roles. Learned voiding behaviors, ageing,
hormonal changes, prior childbirth, previous surgery, dietary habits
and other factors appear to influence this condition.
In contrast to urge incontinence, stress incontinence is primarily
due to weakness of the valve mechanism (sphincter) in the bladder
outlet and urethra. This may be due to intrinsic changes in the urethra,
or loss of support and strength of the bladder neck and adjacent structures
(pelvic relaxation, cystocele, pelvic organ prolapse). It is also
associated with post surgical or radiation changes in men following
treatment for prostate cancer. With physical exertion or activity
that increases abdominal pressure, urine is forced through the deficient
These two types of incontinence can be present separately or in combination.
For this reason, proper evaluation is needed to direct appropriate
Another type of leakage is termed overflow incontinence. This results
from failure of the bladder to empty either from intrinsic weakness,
nerve injury or blockage to flow. With an overfull bladder, exertion
or abdominal pressure can cause urine to spill out. Overflow incontinence
can sometimes be confused with stress and urge incontinence. Proper
evaluation and testing is necessary for correct diagnosis.
Other conditions such as urinary tract fistulae (holes between the
urinary tract and other structures), stroke, spinal cord injury and
other neurologic diseases can also cause incontinence and voiding