Table 1

Classification system and conditions affecting the pathways that control continence

CLASSIFICATIONMECHANISMSDESCRIPTION
StressIntrinsic sphincter deficiency (eg, postsurgical); pelvic floor weakness

  • usually small volume (5–10 mL) loss with cough, sneeze, laugh, etc

UrgeDetrusor hyperreflexia (eg, central causes like stroke, NPH); detrusor instability (eg, local causes such as atrophic vaginitis, bladder cancer)

  • larger volume of urine loss

  • short period of time between onset of urgency and loss of urine

OverflowDetrusor inadequacy (eg, anticholinergic medications, diabetic neuropathy); outflow obstruction (eg, fecal impaction, BPH)

  • constant dribbling with or without sensation of fullness

  • frequency and urgency in older patients

Mixed

  • Functional

Mobility; environmental barriers (eg, bedrails); cognition (eg, unable to recognize need to void or to recognize or use toilet)

  • presence of mobility limitations or moderate to severe dementia

  • environmental barriers especially in institutions (eg, bedrails)

  • BPH—benign prostatic hypertrophy, NPH—normal-pressure hydrocephalus.