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Types of Incontinence

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1)   Irritable/unstable bladder: a feeling of urgency may be accompanied by wetting. This can be due to an over-active bladder muscle (detrusor) or else it may occur if an overstretched bowel presses against the bladder.

2) Reflex incontinence: loss of sensation of bladder fullness and interruption of the messages between the brain and the bladder may cause it to empty by reflex activity which occurs at a spinal level (as in babies) which is usually over-ruled by messages from the brain.

However, in spinal problems, these messages no longer operate properly, so the bladder reverts to reflex emptying. Without sensation to act as a warning, total bladder emptying may occur suddenly and unexpectedly and can therefore be extremely embarrassing.

3) Overflow/dribbling incontinence: if messages to the bladder muscle are disrupted, the muscle becomes weak and unable to empty the bladder properly. This may lead to the bladder becoming large and floppy, able to hold large amounts of urine but leaking slightly. This is therefore known as overflow or dribbling incontinence.

4) Stress incontinence: if muscles in the pelvic floor become weakened, commonly in women after childbirth, the sling that they form, in which the bladder sits, is less able to maintain the correct position of the bladder. The sphincters may thus not stay closed during movements: sudden movements, coughing, sneezing, may all trigger a small loss of urine.

5) Combination incontinence: although this is not an ?official' urological term, I am using it to convey the idea of more than one type of incontinence occurring: so, for example, there may be some irritability coupled with stress incontinence. I am including this category to make the important point that often urological problems are not entirely straightforward.


There are a variety of causes for urinary problems, the commonest being:

a)   Gynaecological: following childbirth, womens' pelvic floor muscles may become weak and the neck of the bladder may therefore no longer be supported adequately.

b)  Infective: urinary tract infection can cause severe discomfort as well as incontinence.

c)   In men, prostate enlargement can cause difficulty in initiating urination, a poor stream and dribbling; the gland may enlarge sufficiently to block the urethra and therefore cause complete retention of urine (see below).