With functional incontinence (mostly older women), urinary storage and
emptying functions are intact but the patient is unable to get to the toilet on time,
whether physically challenged (not moving quickly enough out of a wheelchair
due to arthritis or Parkinson's disease) or psychologically challenged (unclear
thinking or communication due to Alzheimer’s or dementia).
With overflow (hypotonic) incontinence, a rise in bladder pressure occurs
gradually from an overdistended, hypotonic bladder. When the bladder pressure
exceeds the urethral pressure, involuntary urine loss occurs but only until the
bladder pressure equals urethral pressure. The bladder never empties. Then the
process begins all over. This may be caused by denervated bladder (e.g., diabetic
Examination. Pelvic exam may or may not show vaginal prolapse (cystocele,
rectocele, or enterocele). Q-tip test is variable. Pudendal nerve innervation
will be normal.
Investigative studies. Urinalysis will be unremarkable. Cystometry will show
a normal residual volume, but sensation-of-fullness and urge-to-void volume
may be decreased. Involuntary detrusor contractions may be seen.
Management. No single therapy works for everyone; options will be directed
by whether the stress or the urge component is greater.History. Primary finding is inability to toilet oneself in a timely fashion. Loss
of urine can vary, from small leakages to full emptying of the bladder.
Examination. Varies with individual but the bladder support and innervation
are intact.
Investigative studies. Urinalysis and cystometry will be unremarkable.
Involuntary detrusor contractions are not seen.
Management. Treatment of the underlying medical condition; possible
bladder training and pelvic floor exercises (Kegel exercises).