Collectively, these women assume a substantial cost burden. The total annual cost to care for patients with incontinence in the United States is estimated at $11.2 billion in the community and $5.2 billion in nursing homes (9). In the United States, much of this cost is borne directly by women in the form of incontinence pads and excess laundry costs. Despite the burden imposed by leakage, many women do not discuss this symptom with a health care professional. For some women, this is because the leakage does not bother them, whereas others are embarrassed and suffer in silence. Still others do not raise this issue because they mistakenly believe the only treatment option is surgical. It is incumbent on the provider to ask women about leakage.
Studies show that there is little relationship between the volume of urine lost and the distress that it causes a patient (10). The degree to which women are bothered by leakage is inﬂuenced by various factors, including cultural values and expectations regarding urinary continence and incontinence. If the leakage is distressing to the patient, evaluation and treatment should be offered. Incontinence can almost always be improved and frequently can be cured, often using relatively simple, nonsurgical interventions.
Table 26.1 Classification and Definition of Lower Urinary Symptoms in Women
I. Abnormal Storage Symptoms and Signs
Incontinence (symptom) Any involuntary leakage of urine
Stress urinary incontinence Involuntary leakage on effort or exertion, or on sneezing or coughing (symptom)
Stress urinary incontinence Observation of involuntary leakage from the urethra, synchronous with exertion/effort, or sneezing (sign) or coughing
Urgency urinary Involuntary loss of urine associated with urgency incontinence (symptom)
Mixed incontinence Involuntary loss of urine associated with urgency and also with effort or physical exertion or on sneezing or coughing
Continuous urinary Continuous involuntary loss of urine incontinence
Frequency Number of voids per day, from waking in the morning until falling asleep at night
Increased daytime urinary Micturition occurs more frequently during waking hours than previously deemed normal by women frequency (traditionally defined as more than seven episodes)
Nocturia Interruption of sleep one or more times because of the need to micturate (each void is preceded and followed by sleep)
Nocturnal enuresis Involuntary loss of urine that occurs during sleep
Urgency Sudden, compelling desire to pass urine, which is difficult to defer
Postural urinary Involuntary loss of urine associated with change of body position, for example, rising from a seated incontinence or lying position
Insensible urinary Urinary incontinence where the women has been unaware of how it occurred incontinence
Coital incontinence Involuntary loss of urine with coitus. This symptoms might be further divided into that occurring with penetration or intromission and that occurring at organism.
Overactive bladder Urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary syndrome (OAB) incontinence, in the absence of urinary tract infection or other obvious pathology
II. Abnormal Sensory Symptoms
Increased bladder Desire to void during bladder filling occurs earlier or is more persistent from that previous sensation experienced (differs from urgency by the fact that micturition can be postpone despite the desire to void)
From Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the terminology for female pelvic ﬂoor dysfunction. Neurourol Urodyn 2010;29:4–20, with permission.
Types of Disorders