Some Mechanisms of Incontinence
Mechanism | Examples |
|---|---|
Weakness of the urinary sphincter or pelvic muscles (bladder outlet incompetence) | Atrophic urethritis, vaginitis, or both Medications Pelvic muscle weakness (for example, caused by having had several vaginal deliveries or pelvic surgery) Prostate surgery (most often complete removal of the prostate) |
Blockage (bladder outlet obstruction) | Prostate enlargement (benign prostatic hyperplasia) or cancer Medications |
Overactivity of bladder wall muscles (overactive bladder) | Bladder irritation (for example, caused by infection, stones, or rarely cancer) Disorders that can affect brain centers that control urination (such as stroke, dementia, or multiple sclerosis) Cervical spondylosis or spinal cord dysfunction (which can put pressure on the spinal cord and thus impair bladder function) Bladder outlet obstruction |
Underactivity of bladder wall muscles | Nerve damage (for example, by herniated disks, other spinal cord disorders, surgery, tumors, injury, diabetes, or alcohol use disorder) Medications Longstanding bladder outlet obstruction In women, often no identifiable cause |
Poor coordination of the bladder wall with the sphincter muscles | Damage to spinal cord or brain nerve pathways to the bladder |
Functional problems | Dementia Depression Psychoactive medications that can decrease awareness of the need to urinate (for example, antipsychotic medications, benzodiazepines, medications that cause drowsiness such as sedatives and sleep aids, or tricyclic antidepressants) Restricted mobility (for example, caused by injury, weakness, restraints, stroke, other neurologic disorders, or musculoskeletal disorders) Situational limitations (such as not having a toilet nearby or traveling) |
Increase in the volume of urine | Disorders such as diabetes mellitus or diabetes insipidus Excessive intake of caffeinated beverages (such as coffee, tea, cola, or some other soft drinks) or alcohol |