Definitions and Prevalence

Urinary incontinence is the involuntary loss of small or large amounts of urine. The prevalence of urinary incontinence ranges widely according to gender, age, and presence of other risk factors. In general, 20%-30% of the population may have some level of urinary incontinence with the condition being bothersome to about 7%-12%. Prevalence among women is approximately 37% and this may increase with age. However, many patients do not report urinary incontinence, so it has been suggested that prevalence may be higher than the estimates documented. Women generally account for about 85% of urinary incontinence cases.

There are five categories of urinary incontinence, including stress, urge, mixed, overflow, and functional. Each have differing characteristics and may have different treatments.

Fecal incontinence, also known as bowel incontinence or accidental bowel leakage, is the inability to control bowel movements, causing feces to leak unexpectedly from the rectum or before a toilet can be reached. The incontinence severity may range from occasional leakage of feces to a complete loss of bowel control.

Fecal incontinence may occur in about 6% of the population before the age of 40 years increasing to about 15% in older women. The gender distribution approximately equal between men and women. Prevalence varies by setting as well with about 7% to 15% of the population who are not in hospitals or nursing homes. The prevalence increases to between 18% and 33% for adults in hospitals and about 50% to 70% of adults in nursing homes. Prevalence has been estimated as about 2% in children. Women tend to outnumber men by three to one in seeking care. It was suggested that men may be more hesitant to bring the topic up with their health care providers.

Combined urinary and fecal incontinence may be increasing seen with age. The combination tends to be higher in men than in women when associated with aging.

Urinary incontinence      Involuntary leakage of urine Fecal incontinence      Involuntary leakage of stool/feces, mucus

Urinary Incontinence: Risk Factors

There are four main types of urinary incontinence, including stress incontinence, urge incontinence, overflow incontinence, and functional incontinence. There is a fifth type that is called mixed incontinence and it is a combination of stress and urge incontinence types. In general, the risk for urinary incontinence in women is about twice that for men.

Stress incontinence: Urine loss when coughing, sneezing, lifting Most common type Common after childbirth and menopause Urge incontinence Inability to suppress the urge to urinate Infection, stroke, other causes Mixed incontinence: combined stress and urge incontinence Overflow incontinence Lack of bladder muscle contraction with distension beyond capacity Functional incontinence: lack of awareness of need to urinate

Stress incontinence is specifically the involuntary leakage that happens when there are increases intraabdominal pressure and when there is a urethral sphincter or pelvic floor muscle weakness. Generally, pregnant women and women experiencing childbirth are at risk for this type of urinary incontinence. Approximately 24% to 45% of women over the age of 30 years may experience stress incontinence. Menopausal changes can lead to risk for stress incontinence. And, young women who are active in sports can be at risk for stress incontinence.

Urge incontinence results from detrusor muscle overactivity. The detrusor muscle is a smooth muscle in the bladder wall. Generally, this muscle stays relaxed and allows the bladder to store urine. During urination, the detrusor muscle contracts to release urine. In older adults (over 60 years of age) the detrusor muscle may cause uncomfortable urination. Approximately 9% of women between 40-45 years of age and 31% of women over 75 years of age experience urge urinary incontinence. Around 42% of men over the age of 75 years also experience urge incontinence.

The combination of stress and urge incontinence is called mixed incontinence. Approximately 20% to 30% of people with chronic incontinence experience mixed incontinence.

Overflow incontinence is the involuntary loss of urine from an over-distended bladder due to problems with the detrusor muscle contractility and/or obstruction of the bladder outlet. The detrusor muscle can be impaired in cases of neurologic disease, including that seen in spinal cord injuries, multiple sclerosis, and diabetes. Outlet obstruction can be caused by compression by the abdominal or pelvic tissues, pelvic organ prolapse, benign prostatic hyperplasia in men, and other causes. In general, overflow urinary incontinence is experienced by about 5% of people with chronic incontinence and is more common in men than in women.

Functional incontinence is the involuntary leakage of urine related to difficulty toileting. This can happen when there or environmental, physical, or cognitive barriers to toileting. People with physical and/or cognitive impairment are at higher risk for this type of incontinence. The prevalence of functional incontinence in the population or among those with chronic incontinence is uncertain.