Causes of Established Incontinence
Urodynamic Diagnosis | Some Neurologic Causes | Some Nonneurologic Causes |
|---|---|---|
Bladder outlet incompetence | Lower motor neuron lesion (rare) In men, radical prostatectomy* | Intrinsic sphincter deficiency Urethral hypermobility In women, multiple vaginal deliveries, pelvic surgery (eg, hysterectomy), age-related changes (eg, atrophic urethritis) In men, prostate surgery |
Bladder outlet obstruction | Spinal cord lesion causing detrusor-sphincter dyssynergia (rare) | Anterior urethral stricture Urethral diverticula (rarely) or large bladder diverticula (very rarely) Bladder neck suspension surgery In women, cystocele (if large) In men, benign prostatic hyperplasia or prostate cancer |
Detrusor overactivity | Idiopathic Outlet obstruction or incompetence | |
Detrusor underactivity | Autonomic neuropathy (eg, due to diabetes, alcoholism, or vitamin B12 deficiency) Plexopathy Spinal neural tube defect (less often, may cause overactivity) Surgical damage (eg, anteroposterior resection) Tumor | Chronic bladder outlet obstruction Idiopathic (common among women) |
Detrusor-sphincter dyssynergia | Spinal cord lesion Brain lesion affecting pathways to the pontine micturition center | Voiding dysfunction of childhood (poor relaxation of the sphincter with bladder contraction can result from the fear of bed wetting or soiling of clothes) |
* Other prostate surgical procedures rarely cause established incontinence. | ||