Advertisement

Epidemiology, pathophysiology, and evaluation of urinary incontinence and overactive bladder

  • Christopher K. Payne
    Correspondence
    Reprint requests: Christopher K. Payne, MD, Urology Department, 300 Pasteur Drive, S287 Stanford University Medical Center, Stanford, CA 94305-5118
    Affiliations
    From the Center for Female Urology and NeuroUrology, Stanford University Medical Center, Stanford, California, USA
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Objectives. To present an overview of current knowledge regarding the epidemiology, pathophysiology, and evaluation of urinary incontinence (UI) with a focus on the problem of the overactive bladder.
      Methods. The most recent data on the epidemiology of UI are presented. The literature on the pathophysiology of urinary urge incontinence (UUI) is reviewed, and key concepts related to patient evaluation are summarized.
      Results. The prevalence of UI depends on the population being surveyed. The overactive bladder constitutes a substantial percentage of the overall problem, ranging from >50% of incontinent men to only 10% to 15% of incontinent younger women. Few data are available on the incidence of the disorder or on racial/ethnic trends. Overactive bladder or urge incontinence is called detrusor hyperreflexia when a neurologic cause is known and detrusor instability when there is no neurologic abnormality. Although the pathophysiology of idiopathic instability is not well understood, some evidence suggests that this condition may result from subclinical neurologic disease or primary smooth muscle disease. Most patients with UUI can be adequately evaluated with a history, physical examination, determination of postvoid residual volume, and urinalysis. When neurologic disease or other complicating factors are present, or if initial treatment fails, sophisticated urodynamic testing is appropriate.
      Conclusions. Urinary incontinence is prevalent in all strata of the population, although it affects women and the elderly disproportionately. With the exception of cases in which a neurologic lesion can be demonstrated. the etiology of UUI remains elusive. A thorough history, physical examination, determination of postvoid residual, and urinalysis will be adequate to classify and treat the majority of patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lam G.W.
        • Foldspang A.
        • Elving L.B.
        • Mommsen S.
        Social context, social abstention, and problem recognition correlated with adult female urinary incontinence.
        Dan Med Bull. 1992; 39: 565-570
        • Grimby A.
        • Milsom I.
        • Molander U.
        • Wiklund I.
        • Ekelund P.
        The influence of urinary incontinence on the quality of life of elderly women.
        Age Ageing. 1993; 22: 82-89
        • Hunskaar S.
        • Vinsnes A.
        The quality of life in women with urinary incontinence as measured by the sickness impact profile.
        J Am Geriatr Soc. 1991; 39: 378-382
        • Lenderking W.R.
        • Nackley J.F.
        • Anderson R.B.
        • Testa M.A.
        A review of the quality-of-life aspects of urinary urge incontinence.
        PharmacoEconomics. 1996; 9: 11-23
        • Diokno A.C.
        • Brock B.M.
        • Brown M.B.
        • Herzog A.R.
        Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly.
        J Urol. 1986; 136: 1022-1025
        • Thomas T.M.
        • Plymat K.R.
        • Blannin J.
        • Meade T.W.
        Prevalence of urinary incontinence.
        Br Med J. 1980; 281: 1243-1245
        • Burgio K.L.
        • Matthews K.A.
        • Engel B.T.
        Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women.
        J Urol. 1991; 146: 1255-1259
        • Harrison G.L.
        • Memel D.S.
        Urinary incontinence in women: its prevalence and its management in a health promotion clinic.
        Br J Gen Pract. 1994; 44: 149-152
        • Holst K.
        • Wilson P.D.
        The prevalence of female urinary incontinence and reasons for not seeking treatment.
        NZ Med J. 1988; 101: 756-758
        • Lara C.
        • Nacey J.
        Ethnic differences between Maori, Pacific Island and European New Zealand women in prevalence and attitudes to urinary incontinence.
        NZ Med J. 1994; 107: 374-376
        • Nygaard I.E.
        • Thompson F.L.
        • Svengalis S.L.
        • Albright J.P.
        Urinary incontinence in elite nulliparous athletes.
        Obstet Gynecol. 1994; 84: 183-187
        • Nygaard I.E.
        • Lemke J.H.
        Urinary incontinence in rural older women: prevalence, incidence and remission.
        J Am Geriatr Soc. 1996; 44: 1049-1054
        • Stenberg A.
        • Heimer G.
        • Ulmsten U.
        • Cnattingius S.
        Prevalence of genitourinary and other climacteric symptoms in 61-year-old women.
        Maturitas. 1996; 24: 31-36
        • Ouslander J.G.
        • Kane R.L.
        • Abrass I.B.
        Urinary incontinence in elderly nursing home patients.
        JAMA. 1982; 248: 1194-1198
        • Resnick N.M.
        • Yalla S.V.
        • Laurino E.
        The pathophysiology of urinary incontinence among institutionalized elderly persons.
        N Engl J Med. 1989; 320: 1-7
        • Fantl J.A.
        • Wynam J.F.
        • McClish D.K.
        • Bump R.C.
        Urinary incontinence in community-dwelling women: clinical, urodynamic, and severity characteristics.
        Am J Obstet Gynecol. 1990; 162: 946-952
        • Sandvik H.
        • Hunskaar S.
        • Vanvik A.
        • Bratt H.
        • Seim A.
        • Hermstad R.
        Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity.
        J Clin Epidemiol. 1995; 48: 339-343
        • Heslington K.
        • Hilton P.
        Ambulatory monitoring and conventional cystometry in asymptomatic female volunteers.
        Br J Obstet Gynecol. 1996; 103: 434-441
        • Robertson A.S.
        • Griffiths C.J.
        • Ramsden P.D.
        • Neal D.E.
        Bladder function in healthy volunteers: ambulatory monitoring and conventional urodynamic studies.
        Br J Urol. 1994; 73: 242-249
        • van Waalwijk van Doorn E.S.C.
        • Meier A.H.P.
        • Ambergen A.W.
        • Janknegt R.A.
        Ambulatory urodynamics: extramural testing of the lower and upper urinary tract by Holter monitoring of cystometrogram, uroflowmetry, and renal pelvic pressures.
        Urol Clin North Am. 1996; 23: 345-371
        • Heslington K.
        • Hilton P.
        Ambulatory urodynamic monitoring—review.
        Br J Obstet Gynecol. 1996; 103: 393-399
        • Snooks S.J.
        • Swash M.
        • Setchell M.
        • Henry M.M.
        Injury to innervation of pelvic floor sphincter musculature in childbirth.
        Lancet. 1984; ii: 546-550
        • Snooks S.J.
        • Swash M.
        Abnormalities of the innervation of the urethral striated sphincter musculature in incontinence.
        Br J Urol. 1984; 56: 401-405
        • Snooks S.J.
        • Badenoch D.F.
        • Tiptaft R.C.
        • Swash M.
        Perineal nerve damage in genuine stress urinary incontinence.
        Br J Urol. 1985; 57: 422-426
        • Gilpin S.A.
        • Gosling J.A.
        • Smith A.R.B.
        • Warrell D.W.
        The pathogenesis of genitourinary prolapse and stress incontinence of urine. A histological and histochemical study.
        Br J Obstet Gynecol. 1989; 96: 15-23
        • Smith A.R.B.
        • Hosker G.L.
        • Warrell D.W.
        The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study.
        Br J Obstet Gynecol. 1989; 96: 24-28
        • Smith A.R.B.
        • Hosker G.L.
        • Warrell D.W.
        The role of pudendal nerve damage in the aetiology of genuine stress incontinence in women.
        Br J Obstet Gynecol. 1989; 96: 29-32
        • Allen R.E.
        • Hosker G.L.
        • Smith A.R.B.
        • Warrell D.W.
        Pelvic floor damage and childbirth: a neurophysiological study.
        Br J Obstet Gynecol. 1990; 97: 770-779
        • Barnick C.G.W.
        • Cardozo L.D.
        A comparison of bioelectrical and mechanical activity of the female urethra.
        Br J Obstet Gynecol. 1993; 100: 754-757
        • Barnick C.G.W.
        • Cardozo L.D.
        Denervation and reinnervation of the urethral sphincter in the aetiology of genuine stress incontinence: an electromyographic study.
        Br J Obstet Gynecol. 1993; 100: 750-753
        • Vodusek D.B.
        Arguments against the neurogenic hypothesis of stress incontinence.
        (parts 1 and 2)in: International Continence Survey. Reviews of Current Key Literature on Bladder Control. Vol 4. Medicom Europe, Bussum, The Netherlands1994: 11-14 (No. 2)
        • Del Carro U.
        • Riva D.
        • Comi G.C.
        • Locatelli T.
        • Magnani G.
        • Levati N.
        • Viganó Sambruni I.
        • Canal N.
        Neurophysiological evaluation in detrusor instability.
        Neurol Urodyn. 1993; 12: 455-462
        • Kaplan S.A.
        • Te A.E.
        • Blaivas J.G.
        Urodynamic findings in patients with diabetic cystopathy.
        J Urol. 1995; 153: 342-344
        • Elbadawi A.
        • Yalla S.V.
        • Resnick N.M.
        Structural basis of geriatric voiding dysfunction. I. Methods of a prospective ultrastructural/urodynamic study and an overview of the findings.
        J Urol. 1993; 150: 1650-1656
        • Elbadawi A.
        • Yalla S.V.
        • Resnick N.M.
        Structural basis of geriatric voiding dysfunction. III. Detrusor overactivity.
        J Urol. 1993; 150: 1668-1680
        • Urinary Incontinence Guideline Panel
        Urinary Incontinence in Adults: Clinical Practice Guideline.
        in: AHCPR Publication No. 92-0038. Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, Rockville, MD1992
        • Diokno A.C.
        • Wells T.J.
        • Brink C.A.
        Comparison of self-reported voided volume with cystometric bladder capacity.
        J Urol. 1987; 137: 698-700
        • Pannill F.C.
        • Williams T.F.
        • Davis R.
        Evaluation and treatment of urinary incontinence in long-term care.
        J Am Geriatr Soc. 1988; 36: 902-910