Urinary Incontinence Subtypes and Treatment

Definition and Diagnosis

Stress urinary incontinence is a specific subtype of urinary incontinence, characterized by involuntary leakage of urine during physical activities that increase abdominal pressure, such as laughing, lifting, or bending over, according to the European Urology guidelines 1, 2, 3
The underlying mechanism of stress urinary incontinence involves a poorly functioning urethral closure mechanism and loss of anatomical urethral support, causing leakage when intra-abdominal pressure increases, as reported by European Urology 1, 3
Urge urinary incontinence is defined as involuntary leakage accompanied by or immediately preceded by urgency, a sudden, compelling desire to pass urine, as defined by The Journal of Urology and Praxis Medical Insights 4, 5

For stress incontinence, the European Urology guidelines recommend first-line treatment with pelvic floor muscle training with proper supervision, and second-line treatment with surgical interventions including midurethral slings, colposuspension, or autologous fascial slings 1, 2, 3
For urge incontinence, Praxis Medical Insights recommends first-line treatment with behavioral therapies including fluid management, caffeine reduction, and pelvic floor exercises, and second-line treatment with pharmacotherapy using antimuscarinic agents or β3-agonists 4
The American Urological Association is not mentioned in this article, however, The Journal of Urology suggests that treatment for mixed urinary incontinence should target the most bothersome component first 5

For stress incontinence, the diagnostic focus includes history of leakage during physical activities, cough stress test, and assessment of pelvic organ prolapse and urethral hypermobility, as recommended by European Urology and The Journal of Urology 1, 5
For urge incontinence, the diagnostic focus includes urgency episodes documented in voiding diaries, frequency and nocturia patterns, and consideration of urodynamic testing for refractory cases, as suggested by Praxis Medical Insights 4