What causes urinary incontinence?

Updated: Jan 22, 2021
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Even in an individual patient, urinary incontinence may have multiple etiologies, with varying degrees of contribution to the overall disorder. Structural and functional disorders involving the bladder, urethra, ureters, and surrounding connective tissue can contribute. In addition, a disorder of the spinal cord or central nervous system (CNS) may be the major etiologic factor in some cases. Medical comorbidities also can be important. Finally, some cases of urinary incontinence may be pharmacologically induced. [30]

The most common cause of stress incontinence in women is urethral hypermobility secondary to poor anatomic pelvic support. Women may lose this pelvic support with postmenopausal estrogen loss, childbirth, surgery, or certain disease states that affect tissue strength. A less common cause of stress incontinence is intrinsic sphincter deficiency, which can result from the aging process, pelvic trauma, surgery (eg, hysterectomy, [31] urethropexy, pubovaginal sling), or neurologic dysfunction.

The most common cause of intrinsic sphincter deficiency in men is radical prostatectomy for prostate cancer or transurethral resection of the prostate for benign prostatic hyperplasia. A less common cause of intrinsic sphincter deficiency is trauma to the bladder neck or prostate, resulting from pelvic fracture due to high-impact deceleration injuries.

Contributing factors with aging-related urinary incontinence include a weakening of connective tissue, genitourinary atrophy due to hypoestrogenism, increased incidence of contributing medical disorders, increased nocturnal diuresis, and impairments in mobility and cognitive functioning. [10, 32]  Vitamin D deficiency has been identified as a risk factor for urinary incontinence in older adults. [33]

Other factors that may increase the risk of developing incontinence include obesity, straining at stool as a child or young adult, heavy manual labor, chronic obstructive pulmonary disease, and smoking. [34, 35, 36] In many cases of incontinence that are due to detrusor overactivity, the problem is idiopathic in nature.

In a prospective cohort study of 5,391 young women from the Australian Longitudinal Study on Women's Health, depressive symptoms were associated with 37% higher odds of having urinary incontinence after adjustment for sociodemographic factors, body mass index, health behaviors, and reproductive factors. Having physician-diagnosed depression was associated with 42% higher odds. [37]

A review of women with type 1 diabetes mellitus who participated in the Diabetes Control and Complications Trial (DCCT) and its observational follow-up study, the Epidemiology of Diabetes Interventions and Complications (EDIC), found that incident urinary incontinence was associated with higher hemoglobin A1c levels, independent of other recognized risk factors. Thus, improved glycemic control might reduce the risk of urinary incontinence in such patients. [38]

Less frequent causes of urinary incontinence include complications of urologic procedures or pelvic radiation therapy. In the pediatric population, causes include enuresis and congenital abnormalities of the genitourinary system.

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