Materiały źródłowe

• #1 The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

  https://www.mdpi.com/1648-9144/59/1/5

  Stress urinary incontinence is a common disease in middle-aged and elderly women, which seriously affects the physical and mental health of the patients. […] At present, it is believed that the pathogenesis of the disease is mainly due to changes related to age, childbirth, obesity, constipation and other risk factors that induce changes in the urinary control anatomy, including the anatomical factors of the urethra itself, the anatomical factors around the urethra and the anatomical factors of the pelvic nerve. […] Currently, it is believed that the pathogenesis of stress urinary incontinence is mainly due to changes related to age, childbirth, obesity, constipation and other risk factors that induce changes in the urinary control anatomical factors, including the anatomical factors of the urethra itself, the anatomical factors of periurethra and the anatomical factors of the pelvic nerve.

• #2 Urinary Incontinence – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559095/

  Urinary incontinence is the involuntary leakage of urine. This condition is prevalent in older adults but can also affect younger adults and significantly impacts both health and quality of life. The 5 main types include stress, urge, mixed, overflow, and functional incontinence. […] The 5 types of urinary incontinence and their causes are as follows: […] Stress urinary incontinence is the involuntary leakage of urine that occurs with increased intra-abdominal pressure during activities such as exertion, straining, Valsalva, sneezing, or coughing due to the urethral sphincter weakness, pelvic floor weakness, or urethral hypermobility. […] Urge incontinence is the involuntary leakage of urine that may be preceded or accompanied by a sense of urinary urgency (but can be asymptomatic as well) due to detrusor overactivity.

• #3 Pathophysiology of Stress Urinary Incontinence | Plastic Surgery Key

  https://plasticsurgerykey.com/pathophysiology-of-stress-urinary-incontinence/

  The female continence mechanism and factors that contribute to its failure are not completely understood. […] Advances in our knowledge of the histology, biochemistry, and neurophysiology that control bladder neck and urethral support and function have propelled our understanding beyond single factor concepts. […] We now believe that multiple physiologic factors make up the female continence mechanism. Defects alone, or in combination of any of these factors, can contribute to the presence and severity of stress incontinence in women. […] This chapter reviews the anatomic and physiologic mechanisms of urinary continence and the pathophysiology of stress incontinence in women. […] The mechanisms that control urinary continence and voiding are complex. Normal function of the central and peripheral nervous systems, bladder wall, detrusor muscle, urethra, and pelvic floor musculature is required.

• #4 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  Micturition requires coordination of several physiological processes. Somatic and autonomic nerves carry bladder volume input to the spinal cord, and motor output innervating the detrusor, sphincter, and bladder musculature is adjusted accordingly. The cerebral cortex exerts a predominantly inhibitory influence, whereas the brainstem facilitates urination by coordinating urethral sphincter relaxation and detrusor muscle contraction. […] Incontinence occurs when micturition physiology, functional toileting ability, or both have been disrupted. The underlying pathology varies among the different types of incontinence (ie, stress, urge, mixed, reflex, overflow, and functional incontinence). […] During episodes of stress incontinence, an increase in intra-abdominal pressure (eg, from laughing, sneezing, coughing, climbing stairs) raises pressure within the bladder to the point where it exceeds the urethras resistance to urinary flow. Leakage ceases when bladder pressure again falls below urethral pressure.

• #5 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  Micturition requires coordination of several physiological processes. Somatic and autonomic nerves carry bladder volume input to the spinal cord, and motor output innervating the detrusor, sphincter, and bladder musculature is adjusted accordingly. The cerebral cortex exerts a predominantly inhibitory influence, whereas the brainstem facilitates urination by coordinating urethral sphincter relaxation and detrusor muscle contraction. […] Incontinence occurs when micturition physiology, functional toileting ability, or both have been disrupted. The underlying pathology varies among the different types of incontinence (ie, stress, urge, mixed, reflex, overflow, and functional incontinence). […] During episodes of stress incontinence, an increase in intra-abdominal pressure (eg, from laughing, sneezing, coughing, climbing stairs) raises pressure within the bladder to the point where it exceeds the urethras resistance to urinary flow. Leakage ceases when bladder pressure again falls below urethral pressure.

• #6 Urinary incontinence: pathophysiology and management

  https://pavilionhealthtoday.com/gm/urinary-incontinence-jan-2013-report/

  Male and female urethras differ significantly. The female urethra is shorter in length and has a lower external sphincter pressure. Micturition involves the interplay of a number of pathways. The nervous pathways innervating the bladder and its sphincters include sympathetic, parasympathetic and somatic nerve fibres. […] The sympathetic component supplying the bladder and internal sphincter arises from the tenth thoracic to the second lumbar spinal cord segment (T11L2). Sympathetic stimulation is via the hypogastric nerve, which suppresses contraction of the detrusor (active during bladder filling). The parasympathetic component originates from the micturition centre located in the S2 S4 region of the sacral cord. Parasympathetic stimulation is via the pelvic nerve and causes contraction of the detrusor (active during bladder emptying).

• #7 Urinary incontinence: pathophysiology and management

  https://pavilionhealthtoday.com/gm/urinary-incontinence-jan-2013-report/

  Male and female urethras differ significantly. The female urethra is shorter in length and has a lower external sphincter pressure. Micturition involves the interplay of a number of pathways. The nervous pathways innervating the bladder and its sphincters include sympathetic, parasympathetic and somatic nerve fibres. […] The sympathetic component supplying the bladder and internal sphincter arises from the tenth thoracic to the second lumbar spinal cord segment (T11L2). Sympathetic stimulation is via the hypogastric nerve, which suppresses contraction of the detrusor (active during bladder filling). The parasympathetic component originates from the micturition centre located in the S2 S4 region of the sacral cord. Parasympathetic stimulation is via the pelvic nerve and causes contraction of the detrusor (active during bladder emptying).

• #8 Urinary incontinence: pathophysiology and management

  https://pavilionhealthtoday.com/gm/urinary-incontinence-jan-2013-report/

  Male and female urethras differ significantly. The female urethra is shorter in length and has a lower external sphincter pressure. Micturition involves the interplay of a number of pathways. The nervous pathways innervating the bladder and its sphincters include sympathetic, parasympathetic and somatic nerve fibres. […] The sympathetic component supplying the bladder and internal sphincter arises from the tenth thoracic to the second lumbar spinal cord segment (T11L2). Sympathetic stimulation is via the hypogastric nerve, which suppresses contraction of the detrusor (active during bladder filling). The parasympathetic component originates from the micturition centre located in the S2 S4 region of the sacral cord. Parasympathetic stimulation is via the pelvic nerve and causes contraction of the detrusor (active during bladder emptying).

• #9 Urinary incontinence: pathophysiology and management

  https://pavilionhealthtoday.com/gm/urinary-incontinence-jan-2013-report/

  The internal urethral sphincter is composed of smooth muscle and is under the control of the autonomic nervous system. The external sphincter is composed of striated muscle and is under voluntary control, innervated by the pudendal nerve. Finally the somatic component, via the pudendal nerve, arises from the motor neurons originating from S2S4. […] When the bladder fills to a volume of 150ml, you will feel the sense to void. Fullness is reached between 350500mls, this is when you feel the urge to void. A learned reflex prevents you from voiding in a socially unacceptable situation (efferent stimulation from the brain inhibits parasympathetic stimulation of the detrusor muscle causing contraction of the bladder). […] The voiding response requires a coordinated response. As the bladder gets to voiding capacity the bladder stretch receptors are activated and the supraspinal centres block stimulation by the hypogastric and pudendal nerves. This causes relaxation of external urethral sphincter and removes the sympathetic inhibition on the parasympathetic nerves. The parasympathetic cell bodies within the cord are activated and release acetylcholine causing muscle contraction.

• #10 Urinary incontinence: pathophysiology and management

  https://pavilionhealthtoday.com/gm/urinary-incontinence-jan-2013-report/

  The internal urethral sphincter is composed of smooth muscle and is under the control of the autonomic nervous system. The external sphincter is composed of striated muscle and is under voluntary control, innervated by the pudendal nerve. Finally the somatic component, via the pudendal nerve, arises from the motor neurons originating from S2S4. […] When the bladder fills to a volume of 150ml, you will feel the sense to void. Fullness is reached between 350500mls, this is when you feel the urge to void. A learned reflex prevents you from voiding in a socially unacceptable situation (efferent stimulation from the brain inhibits parasympathetic stimulation of the detrusor muscle causing contraction of the bladder). […] The voiding response requires a coordinated response. As the bladder gets to voiding capacity the bladder stretch receptors are activated and the supraspinal centres block stimulation by the hypogastric and pudendal nerves. This causes relaxation of external urethral sphincter and removes the sympathetic inhibition on the parasympathetic nerves. The parasympathetic cell bodies within the cord are activated and release acetylcholine causing muscle contraction.

• #11 PATHOPHYSIOLOGY OF STRESS INCONTINENCE | Abdominal Key

  https://abdominalkey.com/pathophysiology-of-stress-incontinence/

  The lower urinary tract provides continence by storing urine at low pressure until it is socially convenient and appropriate to void. This function is mediated by the presence of an expansible, low-pressure organ, the bladder, and a sphincter-controlled outlet mechanism. The outlet mechanism prevents urinary incontinence during an increase abdominal pressure by means of the sphincter and a complex pelvic support mechanism. Understanding the pathophysiology of stress incontinence at an anatomic level can help to identify specific anatomic defects and direct individualized treatment of patients suffering from incontinence. […] The urethral closure pressure must be greater than the bladder pressure at rest and during increases in abdominal pressure to maintain continence. The anatomic components necessary to meet this goal are a well-vascularized urethral mucosa and submucosa, a well-organized and functioning intrinsic urethral smooth muscle, a properly functioning striated sphincter with intact pudendal innervation (i.e., rhabdosphincter), and a stable, supportive hammock of surrounding muscular and fascial tissues.

• #12 PATHOPHYSIOLOGY OF STRESS INCONTINENCE | Abdominal Key

  https://abdominalkey.com/pathophysiology-of-stress-incontinence/

  The lower urinary tract provides continence by storing urine at low pressure until it is socially convenient and appropriate to void. This function is mediated by the presence of an expansible, low-pressure organ, the bladder, and a sphincter-controlled outlet mechanism. The outlet mechanism prevents urinary incontinence during an increase abdominal pressure by means of the sphincter and a complex pelvic support mechanism. Understanding the pathophysiology of stress incontinence at an anatomic level can help to identify specific anatomic defects and direct individualized treatment of patients suffering from incontinence. […] The urethral closure pressure must be greater than the bladder pressure at rest and during increases in abdominal pressure to maintain continence. The anatomic components necessary to meet this goal are a well-vascularized urethral mucosa and submucosa, a well-organized and functioning intrinsic urethral smooth muscle, a properly functioning striated sphincter with intact pudendal innervation (i.e., rhabdosphincter), and a stable, supportive hammock of surrounding muscular and fascial tissues.

• #13 PATHOPHYSIOLOGY OF STRESS INCONTINENCE | Abdominal Key

  https://abdominalkey.com/pathophysiology-of-stress-incontinence/

  The lower urinary tract provides continence by storing urine at low pressure until it is socially convenient and appropriate to void. This function is mediated by the presence of an expansible, low-pressure organ, the bladder, and a sphincter-controlled outlet mechanism. The outlet mechanism prevents urinary incontinence during an increase abdominal pressure by means of the sphincter and a complex pelvic support mechanism. Understanding the pathophysiology of stress incontinence at an anatomic level can help to identify specific anatomic defects and direct individualized treatment of patients suffering from incontinence. […] The urethral closure pressure must be greater than the bladder pressure at rest and during increases in abdominal pressure to maintain continence. The anatomic components necessary to meet this goal are a well-vascularized urethral mucosa and submucosa, a well-organized and functioning intrinsic urethral smooth muscle, a properly functioning striated sphincter with intact pudendal innervation (i.e., rhabdosphincter), and a stable, supportive hammock of surrounding muscular and fascial tissues.

• #14 PATHOPHYSIOLOGY OF STRESS INCONTINENCE | Abdominal Key

  https://abdominalkey.com/pathophysiology-of-stress-incontinence/

  The lower urinary tract provides continence by storing urine at low pressure until it is socially convenient and appropriate to void. This function is mediated by the presence of an expansible, low-pressure organ, the bladder, and a sphincter-controlled outlet mechanism. The outlet mechanism prevents urinary incontinence during an increase abdominal pressure by means of the sphincter and a complex pelvic support mechanism. Understanding the pathophysiology of stress incontinence at an anatomic level can help to identify specific anatomic defects and direct individualized treatment of patients suffering from incontinence. […] The urethral closure pressure must be greater than the bladder pressure at rest and during increases in abdominal pressure to maintain continence. The anatomic components necessary to meet this goal are a well-vascularized urethral mucosa and submucosa, a well-organized and functioning intrinsic urethral smooth muscle, a properly functioning striated sphincter with intact pudendal innervation (i.e., rhabdosphincter), and a stable, supportive hammock of surrounding muscular and fascial tissues.

• #15 PATHOPHYSIOLOGY OF STRESS INCONTINENCE | Abdominal Key

  https://abdominalkey.com/pathophysiology-of-stress-incontinence/

  The lower urinary tract provides continence by storing urine at low pressure until it is socially convenient and appropriate to void. This function is mediated by the presence of an expansible, low-pressure organ, the bladder, and a sphincter-controlled outlet mechanism. The outlet mechanism prevents urinary incontinence during an increase abdominal pressure by means of the sphincter and a complex pelvic support mechanism. Understanding the pathophysiology of stress incontinence at an anatomic level can help to identify specific anatomic defects and direct individualized treatment of patients suffering from incontinence. […] The urethral closure pressure must be greater than the bladder pressure at rest and during increases in abdominal pressure to maintain continence. The anatomic components necessary to meet this goal are a well-vascularized urethral mucosa and submucosa, a well-organized and functioning intrinsic urethral smooth muscle, a properly functioning striated sphincter with intact pudendal innervation (i.e., rhabdosphincter), and a stable, supportive hammock of surrounding muscular and fascial tissues.

• #16 PATHOPHYSIOLOGY OF STRESS INCONTINENCE | Abdominal Key

  https://abdominalkey.com/pathophysiology-of-stress-incontinence/

  The glandular secretions of the inner mucosa increase the surface tension, promoting its plasticity and increasing its ability to coapt. Estrogenic deficiency in postmenopausal women results in atrophy of this layer, reduces the hermetic seal of the urethra mucosal, and may contribute to the multifactorial cause of stress incontinence. […] The role of smooth muscle in the maintenance of female continence is still uncertain. […] The striated urogenital sphincter consists of two parts, the rhabdosphincter and the compressor urethra and the urethrovaginal sphincter distally. […] Vaginal delivery has been recognized as being potentially traumatic to the pelvic floor. The first delivery may initiate injury to the continence mechanism as a consequence of direct damage to the pelvic floor muscles or nerves, or both, during the passage of the fetus.

• #17 Urinary Incontinence – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559095/

  Urinary incontinence is the involuntary leakage of urine. This condition is prevalent in older adults but can also affect younger adults and significantly impacts both health and quality of life. The 5 main types include stress, urge, mixed, overflow, and functional incontinence. […] The 5 types of urinary incontinence and their causes are as follows: […] Stress urinary incontinence is the involuntary leakage of urine that occurs with increased intra-abdominal pressure during activities such as exertion, straining, Valsalva, sneezing, or coughing due to the urethral sphincter weakness, pelvic floor weakness, or urethral hypermobility. […] Urge incontinence is the involuntary leakage of urine that may be preceded or accompanied by a sense of urinary urgency (but can be asymptomatic as well) due to detrusor overactivity.

• #18 Urinary Incontinence – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559095/

  Urinary incontinence is the involuntary leakage of urine. This condition is prevalent in older adults but can also affect younger adults and significantly impacts both health and quality of life. The 5 main types include stress, urge, mixed, overflow, and functional incontinence. […] The 5 types of urinary incontinence and their causes are as follows: […] Stress urinary incontinence is the involuntary leakage of urine that occurs with increased intra-abdominal pressure during activities such as exertion, straining, Valsalva, sneezing, or coughing due to the urethral sphincter weakness, pelvic floor weakness, or urethral hypermobility. […] Urge incontinence is the involuntary leakage of urine that may be preceded or accompanied by a sense of urinary urgency (but can be asymptomatic as well) due to detrusor overactivity.

• #19 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  Micturition requires coordination of several physiological processes. Somatic and autonomic nerves carry bladder volume input to the spinal cord, and motor output innervating the detrusor, sphincter, and bladder musculature is adjusted accordingly. The cerebral cortex exerts a predominantly inhibitory influence, whereas the brainstem facilitates urination by coordinating urethral sphincter relaxation and detrusor muscle contraction. […] Incontinence occurs when micturition physiology, functional toileting ability, or both have been disrupted. The underlying pathology varies among the different types of incontinence (ie, stress, urge, mixed, reflex, overflow, and functional incontinence). […] During episodes of stress incontinence, an increase in intra-abdominal pressure (eg, from laughing, sneezing, coughing, climbing stairs) raises pressure within the bladder to the point where it exceeds the urethras resistance to urinary flow. Leakage ceases when bladder pressure again falls below urethral pressure.

• #20 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  The major cause of stress incontinence is urethral hypermobility due to impaired support from pelvic floor. A less common cause is an intrinsic sphincter deficiency, usually secondary to pelvic surgeries. In either case, urethral sphincter function is impaired, resulting in urine loss at lower than usual abdominal pressures. […] Urethral hypermobility is related to impaired neuromuscular functioning of the pelvic floor coupled with injury, both remote and ongoing, to the connective tissue supports of the urethra and bladder neck. […] Damage to the nerves, muscle, and connective tissue of the pelvic floor is important in the genesis of stress incontinence. Injury during childbirth probably is the most important mechanism. […] The loss of urethral and bladder neck support may impair urethral closure mechanisms during times of increased intra-abdominal pressure.

• #21 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  The major cause of stress incontinence is urethral hypermobility due to impaired support from pelvic floor. A less common cause is an intrinsic sphincter deficiency, usually secondary to pelvic surgeries. In either case, urethral sphincter function is impaired, resulting in urine loss at lower than usual abdominal pressures. […] Urethral hypermobility is related to impaired neuromuscular functioning of the pelvic floor coupled with injury, both remote and ongoing, to the connective tissue supports of the urethra and bladder neck. […] Damage to the nerves, muscle, and connective tissue of the pelvic floor is important in the genesis of stress incontinence. Injury during childbirth probably is the most important mechanism. […] The loss of urethral and bladder neck support may impair urethral closure mechanisms during times of increased intra-abdominal pressure.

• #22 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  The major cause of stress incontinence is urethral hypermobility due to impaired support from pelvic floor. A less common cause is an intrinsic sphincter deficiency, usually secondary to pelvic surgeries. In either case, urethral sphincter function is impaired, resulting in urine loss at lower than usual abdominal pressures. […] Urethral hypermobility is related to impaired neuromuscular functioning of the pelvic floor coupled with injury, both remote and ongoing, to the connective tissue supports of the urethra and bladder neck. […] Damage to the nerves, muscle, and connective tissue of the pelvic floor is important in the genesis of stress incontinence. Injury during childbirth probably is the most important mechanism. […] The loss of urethral and bladder neck support may impair urethral closure mechanisms during times of increased intra-abdominal pressure.

• #23 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  The major cause of stress incontinence is urethral hypermobility due to impaired support from pelvic floor. A less common cause is an intrinsic sphincter deficiency, usually secondary to pelvic surgeries. In either case, urethral sphincter function is impaired, resulting in urine loss at lower than usual abdominal pressures. […] Urethral hypermobility is related to impaired neuromuscular functioning of the pelvic floor coupled with injury, both remote and ongoing, to the connective tissue supports of the urethra and bladder neck. […] Damage to the nerves, muscle, and connective tissue of the pelvic floor is important in the genesis of stress incontinence. Injury during childbirth probably is the most important mechanism. […] The loss of urethral and bladder neck support may impair urethral closure mechanisms during times of increased intra-abdominal pressure.

• #24 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  The major cause of stress incontinence is urethral hypermobility due to impaired support from pelvic floor. A less common cause is an intrinsic sphincter deficiency, usually secondary to pelvic surgeries. In either case, urethral sphincter function is impaired, resulting in urine loss at lower than usual abdominal pressures. […] Urethral hypermobility is related to impaired neuromuscular functioning of the pelvic floor coupled with injury, both remote and ongoing, to the connective tissue supports of the urethra and bladder neck. […] Damage to the nerves, muscle, and connective tissue of the pelvic floor is important in the genesis of stress incontinence. Injury during childbirth probably is the most important mechanism. […] The loss of urethral and bladder neck support may impair urethral closure mechanisms during times of increased intra-abdominal pressure.

• #25 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  The major cause of stress incontinence is urethral hypermobility due to impaired support from pelvic floor. A less common cause is an intrinsic sphincter deficiency, usually secondary to pelvic surgeries. In either case, urethral sphincter function is impaired, resulting in urine loss at lower than usual abdominal pressures. […] Urethral hypermobility is related to impaired neuromuscular functioning of the pelvic floor coupled with injury, both remote and ongoing, to the connective tissue supports of the urethra and bladder neck. […] Damage to the nerves, muscle, and connective tissue of the pelvic floor is important in the genesis of stress incontinence. Injury during childbirth probably is the most important mechanism. […] The loss of urethral and bladder neck support may impair urethral closure mechanisms during times of increased intra-abdominal pressure.

• #26 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  Intrinsic sphincter deficiency is a condition in which the urethral sphincter is unable to coapt and generate enough resting urethral closing pressure to retain urine in the bladder. […] Urge incontinence is involuntary urine loss associated with a feeling of urgency. The corresponding urodynamic term is detrusor overactivity, which is the observation of involuntary detrusor contractions during filling cystometry. […] Urge incontinence may be a result of detrusor myopathy, neuropathy, or a combination of both. […] Mixed incontinence is urinary incontinence resulting from a combination of stress and urge incontinence. […] Reflex incontinence is due to neurologic impairment of the central nervous system. […] The major contributing factor to overflow incontinence is incomplete bladder emptying secondary to impaired detrusor contractility or bladder outlet obstruction.

• #27 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  Intrinsic sphincter deficiency is a condition in which the urethral sphincter is unable to coapt and generate enough resting urethral closing pressure to retain urine in the bladder. […] Urge incontinence is involuntary urine loss associated with a feeling of urgency. The corresponding urodynamic term is detrusor overactivity, which is the observation of involuntary detrusor contractions during filling cystometry. […] Urge incontinence may be a result of detrusor myopathy, neuropathy, or a combination of both. […] Mixed incontinence is urinary incontinence resulting from a combination of stress and urge incontinence. […] Reflex incontinence is due to neurologic impairment of the central nervous system. […] The major contributing factor to overflow incontinence is incomplete bladder emptying secondary to impaired detrusor contractility or bladder outlet obstruction.

• #28 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  Intrinsic sphincter deficiency is a condition in which the urethral sphincter is unable to coapt and generate enough resting urethral closing pressure to retain urine in the bladder. […] Urge incontinence is involuntary urine loss associated with a feeling of urgency. The corresponding urodynamic term is detrusor overactivity, which is the observation of involuntary detrusor contractions during filling cystometry. […] Urge incontinence may be a result of detrusor myopathy, neuropathy, or a combination of both. […] Mixed incontinence is urinary incontinence resulting from a combination of stress and urge incontinence. […] Reflex incontinence is due to neurologic impairment of the central nervous system. […] The major contributing factor to overflow incontinence is incomplete bladder emptying secondary to impaired detrusor contractility or bladder outlet obstruction.

• #29 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  Intrinsic sphincter deficiency is a condition in which the urethral sphincter is unable to coapt and generate enough resting urethral closing pressure to retain urine in the bladder. […] Urge incontinence is involuntary urine loss associated with a feeling of urgency. The corresponding urodynamic term is detrusor overactivity, which is the observation of involuntary detrusor contractions during filling cystometry. […] Urge incontinence may be a result of detrusor myopathy, neuropathy, or a combination of both. […] Mixed incontinence is urinary incontinence resulting from a combination of stress and urge incontinence. […] Reflex incontinence is due to neurologic impairment of the central nervous system. […] The major contributing factor to overflow incontinence is incomplete bladder emptying secondary to impaired detrusor contractility or bladder outlet obstruction.

• #30 Urinary Incontinence – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559095/

  Mixed urinary incontinence is the involuntary leakage of urine caused by a combination of stress and urge urinary incontinence, as described above. […] Overflow urinary incontinence is the involuntary leakage of urine from an overdistended bladder due to impaired detrusor contractility and bladder outlet obstruction. […] Functional urinary incontinence is the involuntary leakage of urine due to environmental or physical barriers to toileting. […] Management strategies depend on the type and severity of incontinence, and the patient’s discomfort and morbidity. […] Treatment and management of urinary incontinence depends on its type. Conservative, pharmacologic, and surgical treatment modalities exist. […] Type-specific treatment strategies include the following: […] Stress urinary incontinence: Conservative management includes behavioral therapy, including controlling fluid intake, prompted voiding, bladder training, and constipation management; electrical stimulation; mechanical devices, such as cones, pessaries, and urethral plugs; physical therapy; biofeedback; pelvic floor muscle strengthening, such as Kegel and floor muscle exercises; weight loss; pads, such as diapers; condom catheters; and dietary adjustments, such as eliminating caffeine and other irritants.

• #31 Urinary Incontinence – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559095/

  Mixed urinary incontinence is the involuntary leakage of urine caused by a combination of stress and urge urinary incontinence, as described above. […] Overflow urinary incontinence is the involuntary leakage of urine from an overdistended bladder due to impaired detrusor contractility and bladder outlet obstruction. […] Functional urinary incontinence is the involuntary leakage of urine due to environmental or physical barriers to toileting. […] Management strategies depend on the type and severity of incontinence, and the patient’s discomfort and morbidity. […] Treatment and management of urinary incontinence depends on its type. Conservative, pharmacologic, and surgical treatment modalities exist. […] Type-specific treatment strategies include the following: […] Stress urinary incontinence: Conservative management includes behavioral therapy, including controlling fluid intake, prompted voiding, bladder training, and constipation management; electrical stimulation; mechanical devices, such as cones, pessaries, and urethral plugs; physical therapy; biofeedback; pelvic floor muscle strengthening, such as Kegel and floor muscle exercises; weight loss; pads, such as diapers; condom catheters; and dietary adjustments, such as eliminating caffeine and other irritants.

• #32 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  Intrinsic sphincter deficiency is a condition in which the urethral sphincter is unable to coapt and generate enough resting urethral closing pressure to retain urine in the bladder. […] Urge incontinence is involuntary urine loss associated with a feeling of urgency. The corresponding urodynamic term is detrusor overactivity, which is the observation of involuntary detrusor contractions during filling cystometry. […] Urge incontinence may be a result of detrusor myopathy, neuropathy, or a combination of both. […] Mixed incontinence is urinary incontinence resulting from a combination of stress and urge incontinence. […] Reflex incontinence is due to neurologic impairment of the central nervous system. […] The major contributing factor to overflow incontinence is incomplete bladder emptying secondary to impaired detrusor contractility or bladder outlet obstruction.

• #33 Urinary Incontinence – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559095/

  Mixed urinary incontinence is the involuntary leakage of urine caused by a combination of stress and urge urinary incontinence, as described above. […] Overflow urinary incontinence is the involuntary leakage of urine from an overdistended bladder due to impaired detrusor contractility and bladder outlet obstruction. […] Functional urinary incontinence is the involuntary leakage of urine due to environmental or physical barriers to toileting. […] Management strategies depend on the type and severity of incontinence, and the patient’s discomfort and morbidity. […] Treatment and management of urinary incontinence depends on its type. Conservative, pharmacologic, and surgical treatment modalities exist. […] Type-specific treatment strategies include the following: […] Stress urinary incontinence: Conservative management includes behavioral therapy, including controlling fluid intake, prompted voiding, bladder training, and constipation management; electrical stimulation; mechanical devices, such as cones, pessaries, and urethral plugs; physical therapy; biofeedback; pelvic floor muscle strengthening, such as Kegel and floor muscle exercises; weight loss; pads, such as diapers; condom catheters; and dietary adjustments, such as eliminating caffeine and other irritants.

• #34 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  Functional incontinence is seen in patients with normal voiding systems but who have difficulty reaching the toilet because of physical or psychological impediments. […] A unifying theory of the etiology of stress incontinence, urge incontinence, voiding dysfunction, and fecal incontinence in women has been proposed. The basis of the theory is that these disorders are the result of overstretching of the vaginal connective tissue and supporting ligaments, which usually occurs during childbirth.

• #35 The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

  https://www.mdpi.com/1648-9144/59/1/5

  Stress urinary incontinence is a common disease in middle-aged and elderly women, which seriously affects the physical and mental health of the patients. […] At present, it is believed that the pathogenesis of the disease is mainly due to changes related to age, childbirth, obesity, constipation and other risk factors that induce changes in the urinary control anatomy, including the anatomical factors of the urethra itself, the anatomical factors around the urethra and the anatomical factors of the pelvic nerve. […] Currently, it is believed that the pathogenesis of stress urinary incontinence is mainly due to changes related to age, childbirth, obesity, constipation and other risk factors that induce changes in the urinary control anatomical factors, including the anatomical factors of the urethra itself, the anatomical factors of periurethra and the anatomical factors of the pelvic nerve.

• #36 The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

  https://www.mdpi.com/1648-9144/59/1/5

  The weakness of the supporting structure of the bladder neck can lead to the inadequate closure of the bladder neck, so that the posterior wall of the bladder neck collapses, the bladder neck moves downward, and the posterior vesicourethral angle increases or even disappears. […] The anatomical pathogenesis of SUI is very complex, involving the anatomical factors of urethra itself, the periurethra and the pelvic floor nerve. […] Among the many anatomical factors, the levator ani muscle and external urethral sphincter are particularly important. […] When the levator ani muscle and external sphincter of the urethra are dysfunctional, the urethra cannot be closed forcefully, resulting in urinary incontinence.

• #37

  https://link.springer.com/article/10.1007/s00192-020-04622-9

  Damage to or dysfunction of the LAMs is thought to be a contributor to SUI. […] The SUS is considered part of the PFM complex, and it appears to be a major contributor to urinary continence control, along with the smooth muscle surrounding the urethra and bladder neck. […] In light of the complex interactions among tissue morphology, mechanical properties, perfusion, innervation and motor control, several factors may contribute to the pathophysiology of SUI. […] Impairments in urethral and bladder neck structure and support, evidenced through ultrasound imaging and MRI, emerged as being strongly associated with SUI in women. […] Bladder neck dilation (or funneling) emerged through meta-analysis as being highly prevalent in women with SUI. […] Studies included in this review suggest that there is neurophysiological evidence of denervation injury to the SUS in women with SUI.

• #38 Urinary and Fecal Control and Incontinence: Pathogenesis and Mana

  https://www.longdom.org/open-access/urinary-and-fecal-control-and-incontinence-pathogenesis-and-management-17707.html

  Structural damage of the IUS caused in women by CBT leads to a weak sphincter which cannot stand sudden rise of abdominal pressure as on coughing, sneezing /or jumping, will allow some urine to enter the urethra. Urine in the urethra will either cause compelling sensation of desire to void (over active bladder OAB) or escapes (stress urinary incontinence SUI). […] Structural damage of the IAS will lead to fecal incontinence (FI). The structural damage is caused mainly by CBT, but may be caused by direct injury like anal intercourse or forcing a hard object into the anal canal. […] Correction of the torn chassis will restore the normal function.

• #39 Urinary Incontinence in Adults – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/voiding-disorders/urinary-incontinence-in-adults

  Urinary incontinence is involuntary loss of urine; some experts consider it present only when a patient thinks it is a problem. […] Incontinence may occur or worsen with maneuvers that increase intra-abdominal pressure. […] Urge incontinence is uncontrolled urine leakage (of moderate to large volume) that occurs immediately after an urgent, irrepressible need to void. […] In postmenopausal women, decreased estrogen levels lead to atrophic urethritis and atrophic vaginitis and to decreasing urethral resistance, length, and maximum closure pressure. […] In men, prostate size increases, partially obstructing the urethra and leading to incomplete bladder emptying and strain on the detrusor muscle. […] Conceptually, categorization into reversible (transient) or established causes may be useful. However, causes and mechanisms often overlap and occur in combination.

• #40 Urinary Incontinence in Adults – Kidney and Urinary Tract Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/disorders-of-urination/urinary-incontinence-in-adults

  In postmenopausal women, decreased estrogen levels lead to atrophic urethritis and atrophic vaginitis and to decreasing the strength of the urethral sphincter. […] In men, prostate size increases, partially obstructing the urethra and leading to incomplete bladder emptying and strain on the bladder muscle. […] These changes occur in many normal, continent older adults and may facilitate incontinence but do not cause it.

• #41

  https://link.springer.com/article/10.1007/s00192-020-04622-9

  Damage to or dysfunction of the LAMs is thought to be a contributor to SUI. […] The SUS is considered part of the PFM complex, and it appears to be a major contributor to urinary continence control, along with the smooth muscle surrounding the urethra and bladder neck. […] In light of the complex interactions among tissue morphology, mechanical properties, perfusion, innervation and motor control, several factors may contribute to the pathophysiology of SUI. […] Impairments in urethral and bladder neck structure and support, evidenced through ultrasound imaging and MRI, emerged as being strongly associated with SUI in women. […] Bladder neck dilation (or funneling) emerged through meta-analysis as being highly prevalent in women with SUI. […] Studies included in this review suggest that there is neurophysiological evidence of denervation injury to the SUS in women with SUI.

• #42 The mechanism of continence | Clinical Gate

  https://clinicalgate.com/the-mechanism-of-continence/

  If the lower urinary tract is intact, urine flow can only occur when the intravesical pressure exceeds the maximum urethral pressure or when the maximum urethral pressure becomes negative. Causes of this are discussed in later chapters but may be largely due to childbirth, with direct mechanical injury to the supports including muscle and connective tissue, and following denervation injury to those muscles. Ageing also plays a part, as does pelvic floor surgery and radiotherapy. Incontinence, therefore, may occur as a result of: a decrease in urethral pressure associated with an increase in intravesical pressure. This can occur during normal voiding or in cases of detrusor instability; an increase in intravesical pressure associated with an increase in urethral pressure where the latter rise is insufficient to maintain a positive closure pressure. This may be the case in detrusor instability with associated detrusor sphincter dyssynergia; an abnormally steep rise in detrusor pressure during bladder filling, suggesting impaired bladder compliance. This can occur after pelvic irradiation or with conditions that cause chronic inflammation such as tuberculosis or interstitial cystitis; loss of urethral pressure alone. This can occur in urethral instability and also in women who have urethral insufficiency or, as it is otherwise termed, intrinsic sphincter deficiency. This can commonly occur in the menopause, or after radiotherapy or surgery; or during periods of stress, the intravesical pressure rises to a greater extent than the intraurethral pressure. This is usually due to a lack of urethral support, or an abnormally positioned bladder neck and proximal urethra where equal pressure transmission does not occur.

• #43

  https://link.springer.com/article/10.1007/BF00451702

  A urodynamic study was done on 14 normal subjects and 24 with stress urinary incontinence (SUI), aiming to elucidate SUI etiology. […] The results in both normal and SUI subjects showed that coughing caused both vesical and urethral pressure increase, while an increase in vesical pressure only on external urethral sphincter anesthesia. […] In SUI patients, the urethral pressure at rest and on coughing was significantly lower (P0.001) and the functional length shorter than in normal subjects (P0.01). […] The external urethral sphincter EMG activity was below normal. […] The latency of the straining-urethral reflex as well as the PNTML were longer than normal (P0.01). […] Results suggest that urethral pressure increase on coughing is effected by external urethral sphincter contraction and is not transmitted by increased intraabdominal pressure, as evidenced by the urethral sphincter anesthesia test and physioanatomic studies.

• #44

  https://link.springer.com/article/10.1007/BF00451702

  The vesical and urethral descent in SUI is likely to be related to levator subluxation and sagging, which causes levator dysfunction. […] The cause of the weak external urethral sphincter and the prolonged straining-urethral reflex latency seems to be neurogenic, due probably to stretch of the pudendal nerve in the pudendal canal, as evidenced by the prolonged PNTML.

• #45

  https://link.springer.com/article/10.1007/s00192-020-04622-9

  Damage to or dysfunction of the LAMs is thought to be a contributor to SUI. […] The SUS is considered part of the PFM complex, and it appears to be a major contributor to urinary continence control, along with the smooth muscle surrounding the urethra and bladder neck. […] In light of the complex interactions among tissue morphology, mechanical properties, perfusion, innervation and motor control, several factors may contribute to the pathophysiology of SUI. […] Impairments in urethral and bladder neck structure and support, evidenced through ultrasound imaging and MRI, emerged as being strongly associated with SUI in women. […] Bladder neck dilation (or funneling) emerged through meta-analysis as being highly prevalent in women with SUI. […] Studies included in this review suggest that there is neurophysiological evidence of denervation injury to the SUS in women with SUI.

• #46

  https://link.springer.com/article/10.1007/BF00451702

  The vesical and urethral descent in SUI is likely to be related to levator subluxation and sagging, which causes levator dysfunction. […] The cause of the weak external urethral sphincter and the prolonged straining-urethral reflex latency seems to be neurogenic, due probably to stretch of the pudendal nerve in the pudendal canal, as evidenced by the prolonged PNTML.

• #47 Neurogenic Bladder: Overview, Neuroanatomy, Physiology and Pathophysiology

  https://emedicine.medscape.com/article/453539-overview

  The normal function of the urinary bladder is to store and expel urine in a coordinated, controlled fashion. Neurogenic bladder is a term applied to urinary bladder malfunction due to neurologic dysfunction resulting from internal or external trauma, disease, or injury. […] Symptoms of neurogenic bladder range from detrusor underactivity to overactivity, depending on the site of neurologic insult. The urinary sphincter also may be affected, resulting in sphincter underactivity or overactivity and loss of sphincter coordination with bladder function. […] Urinary incontinence results from a dysfunction of the bladder, the sphincter, or both. Overactive bladder is associated with urge incontinence, while sphincter underactivity (decreased resistance) results in stress incontinence. A combination of detrusor overactivity and sphincter underactivity may result in mixed symptoms.

• #48 Neurogenic Bladder: Overview, Neuroanatomy, Physiology and Pathophysiology

  https://emedicine.medscape.com/article/453539-overview

  Lesions of the brain above the pons interrupt the higher conscious control of voiding. The voiding reflexes of the lower urinary tract—the primitive voiding reflex—remain intact. Affected individuals show signs of urge incontinence and experience symptoms of overactive bladder. […] Diseases or injuries of the spinal cord between the pons and the sacral spinal cord also result in overactive bladder, often accompanied by urge incontinence. […] Selected injuries of the sacral cord and the corresponding nerve roots arising from the sacral cord may prevent the bladder from emptying and the patient from sensing a full bladder. […] If the bladder cannot contract, a condition called detrusor areflexia is present, which also leads to the storage of large urine volumes and can be accompanied by overflow incontinence. […] Peripheral nerve lesions resulting in detrusor areflexia may be due to any of the following: Diabetes mellitus, Tabes dorsalis (neurosyphilis), Herpes zoster, Herniated lumbar disc disease, Radical pelvic surgery.

• #49 Urinary Incontinence in Adults – Kidney and Urinary Tract Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/disorders-of-urination/urinary-incontinence-in-adults

  Urinary incontinence is involuntary loss of urine. […] Several mechanisms can lead to urinary incontinence. Often, more than one mechanism is present: […] Weakness of the urinary sphincter or pelvic muscles (called bladder outlet incompetence) […] Something blocking the exit path of urine from the bladder (called bladder outlet obstruction) […] Spasm or overactivity of the bladder wall muscles (sometimes called overactive bladder) […] Weakness or underactivity of the bladder wall muscles […] Poor coordination of the bladder wall muscles with the urinary sphincter […] An increase in the volume of urine […] Functional problems. […] Weakness or underactivity of the bladder wall muscles, bladder outlet obstruction, or particularly both can lead to inability to urinate (urinary retention). Urinary retention can paradoxically lead to overflow incontinence because of leaking from an overly full bladder.

• #50 Urinary Incontinence in Adults – Kidney and Urinary Tract Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/disorders-of-urination/urinary-incontinence-in-adults

  Urinary incontinence is involuntary loss of urine. […] Several mechanisms can lead to urinary incontinence. Often, more than one mechanism is present: […] Weakness of the urinary sphincter or pelvic muscles (called bladder outlet incompetence) […] Something blocking the exit path of urine from the bladder (called bladder outlet obstruction) […] Spasm or overactivity of the bladder wall muscles (sometimes called overactive bladder) […] Weakness or underactivity of the bladder wall muscles […] Poor coordination of the bladder wall muscles with the urinary sphincter […] An increase in the volume of urine […] Functional problems. […] Weakness or underactivity of the bladder wall muscles, bladder outlet obstruction, or particularly both can lead to inability to urinate (urinary retention). Urinary retention can paradoxically lead to overflow incontinence because of leaking from an overly full bladder.

• #51 Pathophysiology of urinary incontinence | PPT

  https://www.slideshare.net/slideshow/pathophysiology-of-urinary-incontinence/73886524

  Urinary incontinence is defined as the involuntary loss of urine, which is both a social and hygienic problem that can be objectively demonstrated. It occurs when the internal sphincter and urethral closure pressure are unable to withstand increases in intra-abdominal pressure due to reductions in the differences between intraurethral and intravesical pressures. […] Urinary incontinence can be caused by various factors like delirium, infection, medications, and age-related changes in the urinary tract. […] It also provides details on the pathophysiology of stress incontinence in terms of urethral hypermobility and intrinsic sphincter dysfunction. […] Internal sphincter Urethral closure pressure Intraurethral pressure- intravesical pressure Normal more than 20cm of water Abdominal pressure Urethra bladder Closure pressure continence incontinencebladder maintaing reducing.

• #52 Causes and Mechanism of Urinary Incontinence

  https://www.longdom.org/open-access/causes-and-mechanism-of-urinary-incontinence-97474.html

  There are urologic and non-urologic causes of urinary incontinence. Detrusor over activity, poor bladder compliance, urethral hypermobility, and intrinsic sphincter deficiencies are examples of urologic reasons that can be categorized as either bladder dysfunction or urethral sphincter incompetence. […] After menopause, estrogen production declines and, in certain women, the urethral tissue will atrophy, weaken, and thin, which may contribute to the emergence of urine incontinence. […] The most typical type of incontinence in men is urge incontinence. […] The urethral sphincter and surrounding tissue can be injured by prostatectomy, transurethral resection of the prostate, prostate brachytherapy, and radiotherapy, rendering them ineffective. […] Age is a risk factor that raises the prevalence and severity of UI.

• #53 Urinary Incontinence in Adults – Kidney and Urinary Tract Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/disorders-of-urination/urinary-incontinence-in-adults

  Overall, the most common causes of incontinence are Overactive bladder in children and young adults […] Pelvic muscle weakness in women as a result of childbirth […] Bladder outlet obstruction in middle-aged men […] Functional disorders such as stroke and dementia in older adults. […] The specific cause of incontinence can often be treated. […] The most effective medications for many kinds of incontinence have anticholinergic effects. […] Although incontinence is more common among older adults, it is not a normal part of aging. […] With aging, bladder capacity decreases, ability to delay urination declines, involuntary bladder contractions occur more often, and bladder contractions weaken. […] The muscles, ligaments, and connective tissue of the pelvis weaken, contributing to incontinence.

• #54 Urinary Incontinence in Adults – Kidney and Urinary Tract Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/disorders-of-urination/urinary-incontinence-in-adults

  Overall, the most common causes of incontinence are Overactive bladder in children and young adults […] Pelvic muscle weakness in women as a result of childbirth […] Bladder outlet obstruction in middle-aged men […] Functional disorders such as stroke and dementia in older adults. […] The specific cause of incontinence can often be treated. […] The most effective medications for many kinds of incontinence have anticholinergic effects. […] Although incontinence is more common among older adults, it is not a normal part of aging. […] With aging, bladder capacity decreases, ability to delay urination declines, involuntary bladder contractions occur more often, and bladder contractions weaken. […] The muscles, ligaments, and connective tissue of the pelvis weaken, contributing to incontinence.

• #55 PATHOPHYSIOLOGY OF STRESS INCONTINENCE | Abdominal Key

  https://abdominalkey.com/pathophysiology-of-stress-incontinence/

  The glandular secretions of the inner mucosa increase the surface tension, promoting its plasticity and increasing its ability to coapt. Estrogenic deficiency in postmenopausal women results in atrophy of this layer, reduces the hermetic seal of the urethra mucosal, and may contribute to the multifactorial cause of stress incontinence. […] The role of smooth muscle in the maintenance of female continence is still uncertain. […] The striated urogenital sphincter consists of two parts, the rhabdosphincter and the compressor urethra and the urethrovaginal sphincter distally. […] Vaginal delivery has been recognized as being potentially traumatic to the pelvic floor. The first delivery may initiate injury to the continence mechanism as a consequence of direct damage to the pelvic floor muscles or nerves, or both, during the passage of the fetus.

• #56 PATHOPHYSIOLOGY OF STRESS INCONTINENCE | Abdominal Key

  https://abdominalkey.com/pathophysiology-of-stress-incontinence/

  The fetal head may dilate and overstretch the vaginal wall or avulse the cardinal and uterosacral ligaments, injuring connective support tissues. Moreover, the presenting part of the fetus during labor may constrict the pelvic structures, resulting in an ischemic injury. […] There are many mechanisms by which vaginal delivery can increase the risk of developing stress incontinence. […] Vaginal delivery causes partial denervation of the pelvic floor in most primiparous women, but there is electromyographic evidence of reinnervation after vaginal delivery in 80% of them.

• #57 The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

  https://www.mdpi.com/1648-9144/59/1/5

  Stress urinary incontinence is a common disease in middle-aged and elderly women, which seriously affects the physical and mental health of the patients. […] At present, it is believed that the pathogenesis of the disease is mainly due to changes related to age, childbirth, obesity, constipation and other risk factors that induce changes in the urinary control anatomy, including the anatomical factors of the urethra itself, the anatomical factors around the urethra and the anatomical factors of the pelvic nerve. […] Currently, it is believed that the pathogenesis of stress urinary incontinence is mainly due to changes related to age, childbirth, obesity, constipation and other risk factors that induce changes in the urinary control anatomical factors, including the anatomical factors of the urethra itself, the anatomical factors of periurethra and the anatomical factors of the pelvic nerve.

• #58 The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

  https://www.mdpi.com/1648-9144/59/1/5

  Stress urinary incontinence is a common disease in middle-aged and elderly women, which seriously affects the physical and mental health of the patients. […] At present, it is believed that the pathogenesis of the disease is mainly due to changes related to age, childbirth, obesity, constipation and other risk factors that induce changes in the urinary control anatomy, including the anatomical factors of the urethra itself, the anatomical factors around the urethra and the anatomical factors of the pelvic nerve. […] Currently, it is believed that the pathogenesis of stress urinary incontinence is mainly due to changes related to age, childbirth, obesity, constipation and other risk factors that induce changes in the urinary control anatomical factors, including the anatomical factors of the urethra itself, the anatomical factors of periurethra and the anatomical factors of the pelvic nerve.

• #59 Urinary Incontinence – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/urology/bladder/urinary-incontinence/

  Urinary incontinence (UI) is the involuntary leakage of urine. It affects around 15% of the general population, most common in the elderly, and is more common in females (male: female 1:3). UI can be categorised into various subtypes, all of which have different underlying causes and management options: Stress incontinence, Urge incontinence, Mixed incontinence, Overflow incontinence, and Continuous incontinence. […] Stress UI is urine leakage occurring when the intra-abdominal pressure exceeds the urethral pressure, such as coughing, straining, laughing, or lifting. The impaired urethral support is most often due to weakness of the pelvic floor muscle. It is most commonly seen post-partum, due to the damage occurring to the pelvic floor muscles, weakening the urethral sphincter. Other risk factors include constipation (due to recurrent straining), obesity, post-menopausal, or pelvic surgery (e.g. TURP, resulting in external sphincter damage).

• #60 Causes and Mechanism of Urinary Incontinence

  https://www.longdom.org/open-access/causes-and-mechanism-of-urinary-incontinence-97474.html

  There are urologic and non-urologic causes of urinary incontinence. Detrusor over activity, poor bladder compliance, urethral hypermobility, and intrinsic sphincter deficiencies are examples of urologic reasons that can be categorized as either bladder dysfunction or urethral sphincter incompetence. […] After menopause, estrogen production declines and, in certain women, the urethral tissue will atrophy, weaken, and thin, which may contribute to the emergence of urine incontinence. […] The most typical type of incontinence in men is urge incontinence. […] The urethral sphincter and surrounding tissue can be injured by prostatectomy, transurethral resection of the prostate, prostate brachytherapy, and radiotherapy, rendering them ineffective. […] Age is a risk factor that raises the prevalence and severity of UI.

• #61 Drug-Induced Urinary Incontinence

  https://www.uspharmacist.com/article/druginduced-urinary-incontinence

  The purpose of a diuretic is to increase the formation of urine by the kidneys. […] Calcium channel blockers decrease smooth-muscle contractility in the bladder. This causes urinary retention and, accordingly, leads to overflow incontinence. […] Sedative-hypnotics result in immobility secondary to sedation that leads to functional incontinence. […] Blocking angiotensin receptors with ACE inhibitors or angiotensin receptor blockers decreases both detrusor overactivity and urethral sphincter tone, leading to reduced urge incontinence and increased stress urinary incontinence. […] One study showed that oral and transdermal estrogen, with or without progestin, increased the risk of urinary incontinence by 45% to 60% in community-dwelling elderly women. […] Hydroxychloroquine has recently been identified as an agent that can induce urinary incontinence.

• #62 Urinary Incontinence in Adults – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/voiding-disorders/urinary-incontinence-in-adults

  Urinary incontinence is involuntary loss of urine; some experts consider it present only when a patient thinks it is a problem. […] Incontinence may occur or worsen with maneuvers that increase intra-abdominal pressure. […] Urge incontinence is uncontrolled urine leakage (of moderate to large volume) that occurs immediately after an urgent, irrepressible need to void. […] In postmenopausal women, decreased estrogen levels lead to atrophic urethritis and atrophic vaginitis and to decreasing urethral resistance, length, and maximum closure pressure. […] In men, prostate size increases, partially obstructing the urethra and leading to incomplete bladder emptying and strain on the detrusor muscle. […] Conceptually, categorization into reversible (transient) or established causes may be useful. However, causes and mechanisms often overlap and occur in combination.

• #63 Urinary Incontinence in Adults – Kidney and Urinary Tract Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/disorders-of-urination/urinary-incontinence-in-adults

  In postmenopausal women, decreased estrogen levels lead to atrophic urethritis and atrophic vaginitis and to decreasing the strength of the urethral sphincter. […] In men, prostate size increases, partially obstructing the urethra and leading to incomplete bladder emptying and strain on the bladder muscle. […] These changes occur in many normal, continent older adults and may facilitate incontinence but do not cause it.

• #64 Causes and Mechanism of Urinary Incontinence

  https://www.longdom.org/open-access/causes-and-mechanism-of-urinary-incontinence-97474.html

  There are urologic and non-urologic causes of urinary incontinence. Detrusor over activity, poor bladder compliance, urethral hypermobility, and intrinsic sphincter deficiencies are examples of urologic reasons that can be categorized as either bladder dysfunction or urethral sphincter incompetence. […] After menopause, estrogen production declines and, in certain women, the urethral tissue will atrophy, weaken, and thin, which may contribute to the emergence of urine incontinence. […] The most typical type of incontinence in men is urge incontinence. […] The urethral sphincter and surrounding tissue can be injured by prostatectomy, transurethral resection of the prostate, prostate brachytherapy, and radiotherapy, rendering them ineffective. […] Age is a risk factor that raises the prevalence and severity of UI.

• #65 Causes and Mechanism of Urinary Incontinence

  https://www.longdom.org/open-access/causes-and-mechanism-of-urinary-incontinence-97474.html

  There are urologic and non-urologic causes of urinary incontinence. Detrusor over activity, poor bladder compliance, urethral hypermobility, and intrinsic sphincter deficiencies are examples of urologic reasons that can be categorized as either bladder dysfunction or urethral sphincter incompetence. […] After menopause, estrogen production declines and, in certain women, the urethral tissue will atrophy, weaken, and thin, which may contribute to the emergence of urine incontinence. […] The most typical type of incontinence in men is urge incontinence. […] The urethral sphincter and surrounding tissue can be injured by prostatectomy, transurethral resection of the prostate, prostate brachytherapy, and radiotherapy, rendering them ineffective. […] Age is a risk factor that raises the prevalence and severity of UI.

• #66 Urinary Incontinence: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/452289-overview

  Functional incontinence is seen in patients with normal voiding systems but who have difficulty reaching the toilet because of physical or psychological impediments. […] A unifying theory of the etiology of stress incontinence, urge incontinence, voiding dysfunction, and fecal incontinence in women has been proposed. The basis of the theory is that these disorders are the result of overstretching of the vaginal connective tissue and supporting ligaments, which usually occurs during childbirth.

• #67

  https://link.springer.com/article/10.1007/s00192-020-04622-9

  To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women. […] Deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS) and levator ani muscles all appear to be associated with SUI. […] The pathology of SUI is multifactorial, with strong evidence pointing to bladder neck and urethral incompetence. […] Prevailing theory suggests a combination of disruption in the supportive connective tissues of the bladder and urethra and weakening of the muscular structures of the pelvic floor, bladder neck and urethral sphincters all lead to reduced urethral closure pressure and lower ALPP, functionally resulting in SUI. […] Impaired anatomical support of the bladder neck and proximal urethra is associated with urethral hypermobility, which is thought to impede the transfer of loads induced by the descending pelvic structures to the urethra, resulting in less extrinsic closure force, and ultimately with urine leakage.

• #68

  https://link.springer.com/article/10.1007/s00192-020-04622-9

  To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women. […] Deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS) and levator ani muscles all appear to be associated with SUI. […] The pathology of SUI is multifactorial, with strong evidence pointing to bladder neck and urethral incompetence. […] Prevailing theory suggests a combination of disruption in the supportive connective tissues of the bladder and urethra and weakening of the muscular structures of the pelvic floor, bladder neck and urethral sphincters all lead to reduced urethral closure pressure and lower ALPP, functionally resulting in SUI. […] Impaired anatomical support of the bladder neck and proximal urethra is associated with urethral hypermobility, which is thought to impede the transfer of loads induced by the descending pelvic structures to the urethra, resulting in less extrinsic closure force, and ultimately with urine leakage.

• #69 A brief physiology and pathophysiology of the bladder

  https://atm.amegroups.org/article/view/123658/html

  The pathogenesis of female urinary incontinence is from outside the bladder, mainly weak ligaments or vagina, due to collagen deficiency. […] Weak ligaments are an important cause of SUI, urgency (OAB), and emptying dysfunctions [underactive bladder (UAB)]. […] The integral theory paradigm (ITP)’s main focus is loose or weak ligaments caused by altered collagen. […] Pathogenesis can be congenital, pregnancy/childbirth related or menopausal (collagen breakdown/excretion). […] Any abnormality in the binary control circuit can affect the micturition reflex to cause retention or OAB. […] A urodynamically controlled experiment demonstrated what was then known as detrusor instability (now DO) was equivalent to a prematurely activated micturition. […] Weak USLs weaken the contractile force of the LP and LMA muscles which contract against them.

• #70 A brief physiology and pathophysiology of the bladder

  https://atm.amegroups.org/article/view/123658/html

  A loose USL cannot prevent the proximal vagina and bladder base from being pulled down by gravity. […] The reason behind female urinary incontinence has to be looked for outside the bladder, that is, in the structures supporting the urethra and bladder neck, specifically, ligaments, pelvic floor muscles and vagina. […] Since the early 1990s, surgeons who follow the ITP have been reporting high cure rates for SUI, OAB, urinary retention and chronic pelvic pain, by repair of the suspensory ligaments of the pelvis, principally the PUL and USL.

• #71 Drug-Induced Urinary Incontinence

  https://www.uspharmacist.com/article/druginduced-urinary-incontinence

  Urinary incontinence affects both men and women, and especially the elderly. Pharmacologic agents including oral estrogens, alpha-blockers, sedative-hypnotics, antidepressants, antipsychotics, ACE inhibitors, loop diuretics, nonsteroidal anti-inflammatory drugs, and calcium channel blockers have been implicated to some degree in the onset or exacerbation of urinary incontinence. […] Disturbances of this storage function of the bladder lead to urinary incontinence. A number of factors may be responsible, including disease and adverse effects of medical treatment. […] A number of medications have been proposed as possible causes of drug-induced urinary incontinence, including alpha1-adrenoceptor antagonists, antipsychotics, benzodiazepines, antidepressants, and drugs used for hormone replacement therapy.

• #72 Drug-Induced Urinary Incontinence

  https://www.uspharmacist.com/article/druginduced-urinary-incontinence

  As described earlier, the stimulation of alpha1-adrenoceptors by norepinephrine leads to increased bladder outlet resistance. […] Blocking these receptors with such agents as prazosin, doxazosin, and terazosin would therefore lead to reduced bladder outlet resistance and, accordingly, to incontinence. […] Typical antipsychotics are primarily dopamine antagonists and lead to stress urinary incontinence, whereas atypical antipsychotics are antagonists at serotonin receptors. […] Antipsychotics also cause incontinence by one or more of the following mechanisms: alpha-adrenergic blockade, dopamine blockade, and cholinergic actions on the bladder. […] There are a number of classes of antidepressants, all with varying pharmacologic properties. This makes it difficult to generalize the underlying mechanisms that lead to urinary incontinence as a result of antidepressant use.

• #73 Drug-Induced Urinary Incontinence

  https://www.uspharmacist.com/article/druginduced-urinary-incontinence

  As described earlier, the stimulation of alpha1-adrenoceptors by norepinephrine leads to increased bladder outlet resistance. […] Blocking these receptors with such agents as prazosin, doxazosin, and terazosin would therefore lead to reduced bladder outlet resistance and, accordingly, to incontinence. […] Typical antipsychotics are primarily dopamine antagonists and lead to stress urinary incontinence, whereas atypical antipsychotics are antagonists at serotonin receptors. […] Antipsychotics also cause incontinence by one or more of the following mechanisms: alpha-adrenergic blockade, dopamine blockade, and cholinergic actions on the bladder. […] There are a number of classes of antidepressants, all with varying pharmacologic properties. This makes it difficult to generalize the underlying mechanisms that lead to urinary incontinence as a result of antidepressant use.

• #74 Drug-Induced Urinary Incontinence

  https://www.uspharmacist.com/article/druginduced-urinary-incontinence

  As described earlier, the stimulation of alpha1-adrenoceptors by norepinephrine leads to increased bladder outlet resistance. […] Blocking these receptors with such agents as prazosin, doxazosin, and terazosin would therefore lead to reduced bladder outlet resistance and, accordingly, to incontinence. […] Typical antipsychotics are primarily dopamine antagonists and lead to stress urinary incontinence, whereas atypical antipsychotics are antagonists at serotonin receptors. […] Antipsychotics also cause incontinence by one or more of the following mechanisms: alpha-adrenergic blockade, dopamine blockade, and cholinergic actions on the bladder. […] There are a number of classes of antidepressants, all with varying pharmacologic properties. This makes it difficult to generalize the underlying mechanisms that lead to urinary incontinence as a result of antidepressant use.

• #75 Drug-Induced Urinary Incontinence

  https://www.uspharmacist.com/article/druginduced-urinary-incontinence

  The purpose of a diuretic is to increase the formation of urine by the kidneys. […] Calcium channel blockers decrease smooth-muscle contractility in the bladder. This causes urinary retention and, accordingly, leads to overflow incontinence. […] Sedative-hypnotics result in immobility secondary to sedation that leads to functional incontinence. […] Blocking angiotensin receptors with ACE inhibitors or angiotensin receptor blockers decreases both detrusor overactivity and urethral sphincter tone, leading to reduced urge incontinence and increased stress urinary incontinence. […] One study showed that oral and transdermal estrogen, with or without progestin, increased the risk of urinary incontinence by 45% to 60% in community-dwelling elderly women. […] Hydroxychloroquine has recently been identified as an agent that can induce urinary incontinence.

• #76 Drug-Induced Urinary Incontinence

  https://www.uspharmacist.com/article/druginduced-urinary-incontinence

  The purpose of a diuretic is to increase the formation of urine by the kidneys. […] Calcium channel blockers decrease smooth-muscle contractility in the bladder. This causes urinary retention and, accordingly, leads to overflow incontinence. […] Sedative-hypnotics result in immobility secondary to sedation that leads to functional incontinence. […] Blocking angiotensin receptors with ACE inhibitors or angiotensin receptor blockers decreases both detrusor overactivity and urethral sphincter tone, leading to reduced urge incontinence and increased stress urinary incontinence. […] One study showed that oral and transdermal estrogen, with or without progestin, increased the risk of urinary incontinence by 45% to 60% in community-dwelling elderly women. […] Hydroxychloroquine has recently been identified as an agent that can induce urinary incontinence.

• #77 Drug-Induced Urinary Incontinence

  https://www.uspharmacist.com/article/druginduced-urinary-incontinence

  The purpose of a diuretic is to increase the formation of urine by the kidneys. […] Calcium channel blockers decrease smooth-muscle contractility in the bladder. This causes urinary retention and, accordingly, leads to overflow incontinence. […] Sedative-hypnotics result in immobility secondary to sedation that leads to functional incontinence. […] Blocking angiotensin receptors with ACE inhibitors or angiotensin receptor blockers decreases both detrusor overactivity and urethral sphincter tone, leading to reduced urge incontinence and increased stress urinary incontinence. […] One study showed that oral and transdermal estrogen, with or without progestin, increased the risk of urinary incontinence by 45% to 60% in community-dwelling elderly women. […] Hydroxychloroquine has recently been identified as an agent that can induce urinary incontinence.

• #78 Drug-Induced Urinary Incontinence

  https://www.uspharmacist.com/article/druginduced-urinary-incontinence

  The purpose of a diuretic is to increase the formation of urine by the kidneys. […] Calcium channel blockers decrease smooth-muscle contractility in the bladder. This causes urinary retention and, accordingly, leads to overflow incontinence. […] Sedative-hypnotics result in immobility secondary to sedation that leads to functional incontinence. […] Blocking angiotensin receptors with ACE inhibitors or angiotensin receptor blockers decreases both detrusor overactivity and urethral sphincter tone, leading to reduced urge incontinence and increased stress urinary incontinence. […] One study showed that oral and transdermal estrogen, with or without progestin, increased the risk of urinary incontinence by 45% to 60% in community-dwelling elderly women. […] Hydroxychloroquine has recently been identified as an agent that can induce urinary incontinence.

• #79 Drug-Induced Urinary Incontinence

  https://www.uspharmacist.com/article/druginduced-urinary-incontinence

  The purpose of a diuretic is to increase the formation of urine by the kidneys. […] Calcium channel blockers decrease smooth-muscle contractility in the bladder. This causes urinary retention and, accordingly, leads to overflow incontinence. […] Sedative-hypnotics result in immobility secondary to sedation that leads to functional incontinence. […] Blocking angiotensin receptors with ACE inhibitors or angiotensin receptor blockers decreases both detrusor overactivity and urethral sphincter tone, leading to reduced urge incontinence and increased stress urinary incontinence. […] One study showed that oral and transdermal estrogen, with or without progestin, increased the risk of urinary incontinence by 45% to 60% in community-dwelling elderly women. […] Hydroxychloroquine has recently been identified as an agent that can induce urinary incontinence.

• #80 Investigating the mechanism underlying urinary continence using dynamic MRI after Retzius-sparing robot-assisted radical prostatectomy | Scientific Reports

  https://www.nature.com/articles/s41598-022-07800-5

  Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) exhibits better postoperative urinary continence than conventional RARP (C-RARP) via the anterior approach. […] The median urine loss ratios in the early postoperative period after C-RARP and RS-RARP were 11.0% and 1.0%, respectively. […] Dynamic MRI after C-RARP showed that cephalocaudal compression of the bladder while applying abdominal pressure caused the membranous urethra to expand and the urine to flow out. After RS-RARP, the rectum moved forward during abdominal pressure, and the membranous urethra was compressed by closure from behind. […] This is the first study using dynamic MRI to reveal the importance of high attachment of the anterior bladder wall for the urethral closure mechanism during abdominal pressure.

• #81 Evidence of Common Pathophysiology Between Stress and Urgency Urinary Incontinence in Women | In Vivo

  https://iv.iiarjournals.org/content/34/5/2927

  We interpreted this effect on urinary incontinence as a stabilization of the UVJ. […] Urinary continence must be dependent on an effective closing mechanism of the bladder outlet. […] The urgency to void is induced by stretch receptors at the bladder base at the UVJ. […] Urinary continence or incontinence is then a balance of pressure and counterpressure in the region of the UVJ. Therefore, medical treatment can affect urgency but urinary continence should be achieved by an anatomical support of the UVJ. […] This study demonstrated that urinary incontinence in patients with UUI is caused by stress exerted on the UVJ. If the pressure exerted on the UVJ exceeds the counterpressure of an intact UVJ the patients loses urine. Treatment of urinary incontinence must therefore focus on the anatomical repair or support in that area.

• #82 Evidence of Common Pathophysiology Between Stress and Urgency Urinary Incontinence in Women | In Vivo

  https://iv.iiarjournals.org/content/34/5/2927

  We interpreted this effect on urinary incontinence as a stabilization of the UVJ. […] Urinary continence must be dependent on an effective closing mechanism of the bladder outlet. […] The urgency to void is induced by stretch receptors at the bladder base at the UVJ. […] Urinary continence or incontinence is then a balance of pressure and counterpressure in the region of the UVJ. Therefore, medical treatment can affect urgency but urinary continence should be achieved by an anatomical support of the UVJ. […] This study demonstrated that urinary incontinence in patients with UUI is caused by stress exerted on the UVJ. If the pressure exerted on the UVJ exceeds the counterpressure of an intact UVJ the patients loses urine. Treatment of urinary incontinence must therefore focus on the anatomical repair or support in that area.

• #83 Mechanisms of pelvic floor muscle training for managing urinary incontinence in women: a scoping review | BMC Women’s Health | Full Text

  https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-022-01742-w

  Pelvic floor muscle training is recommended as first line treatment for urinary incontinence in women based on three proposed theorized mechanisms: Enhanced Pelvic Floor Muscle Strength, Maximized Awareness of Timing, and Strengthened Core Muscles. […] There was weak to no evidence for the mechanism of enhanced pelvic floor muscle strength, equivocal support for maximized awareness of timing, and no evidence for strengthened core muscles. […] This review revealed extremely limited data supporting the proposed theorized mechanisms underlying pelvic floor muscle training programs to manage urinary incontinence in women. […] The first and dominant mechanism is Enhanced Pelvic Floor Muscle Strength, pertaining to increasing the cross-sectional area of the key support muscle underlying the urethra.

• #84 Investigating the mechanism underlying urinary continence using dynamic MRI after Retzius-sparing robot-assisted radical prostatectomy | Scientific Reports

  https://www.nature.com/articles/s41598-022-07800-5

  It would be advantageous to fix the anterior surface of the bladder to the abdominal wall at a high position to close the urethra during abdominal pressure. […] In the present study, the bladder was fixed at a higher position, which compressed the external urethral sphincter more in patients who underwent RS-RARP than in those who underwent C-RARP, which may have resulted in less urinary incontinence. […] The mechanism of SUI after RP is slightly different from the mechanism of SUI associated with urethral hypermobility in women. […] However, similar to women, urinary incontinence is caused by insufficient urethral closing pressure when pressure is applied distally from the bladder neck during abdominal pressure. […] In this study, we examined the pelvic anatomy before and after RARP using MRI.

• #85

  https://link.springer.com/article/10.1007/s00192-020-04622-9

  To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women. […] Deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS) and levator ani muscles all appear to be associated with SUI. […] The pathology of SUI is multifactorial, with strong evidence pointing to bladder neck and urethral incompetence. […] Prevailing theory suggests a combination of disruption in the supportive connective tissues of the bladder and urethra and weakening of the muscular structures of the pelvic floor, bladder neck and urethral sphincters all lead to reduced urethral closure pressure and lower ALPP, functionally resulting in SUI. […] Impaired anatomical support of the bladder neck and proximal urethra is associated with urethral hypermobility, which is thought to impede the transfer of loads induced by the descending pelvic structures to the urethra, resulting in less extrinsic closure force, and ultimately with urine leakage.

• #86 The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

  https://www.mdpi.com/1648-9144/59/1/5

  The weakness of the supporting structure of the bladder neck can lead to the inadequate closure of the bladder neck, so that the posterior wall of the bladder neck collapses, the bladder neck moves downward, and the posterior vesicourethral angle increases or even disappears. […] The anatomical pathogenesis of SUI is very complex, involving the anatomical factors of urethra itself, the periurethra and the pelvic floor nerve. […] Among the many anatomical factors, the levator ani muscle and external urethral sphincter are particularly important. […] When the levator ani muscle and external sphincter of the urethra are dysfunctional, the urethra cannot be closed forcefully, resulting in urinary incontinence.

• #87 The Anatomical Pathogenesis of Stress Urinary Incontinence in Women

  https://www.mdpi.com/1648-9144/59/1/5

  The weakness of the supporting structure of the bladder neck can lead to the inadequate closure of the bladder neck, so that the posterior wall of the bladder neck collapses, the bladder neck moves downward, and the posterior vesicourethral angle increases or even disappears. […] The anatomical pathogenesis of SUI is very complex, involving the anatomical factors of urethra itself, the periurethra and the pelvic floor nerve. […] Among the many anatomical factors, the levator ani muscle and external urethral sphincter are particularly important. […] When the levator ani muscle and external sphincter of the urethra are dysfunctional, the urethra cannot be closed forcefully, resulting in urinary incontinence.

• #88

  https://link.springer.com/article/10.1007/s00192-020-04622-9

  Damage to or dysfunction of the LAMs is thought to be a contributor to SUI. […] The SUS is considered part of the PFM complex, and it appears to be a major contributor to urinary continence control, along with the smooth muscle surrounding the urethra and bladder neck. […] In light of the complex interactions among tissue morphology, mechanical properties, perfusion, innervation and motor control, several factors may contribute to the pathophysiology of SUI. […] Impairments in urethral and bladder neck structure and support, evidenced through ultrasound imaging and MRI, emerged as being strongly associated with SUI in women. […] Bladder neck dilation (or funneling) emerged through meta-analysis as being highly prevalent in women with SUI. […] Studies included in this review suggest that there is neurophysiological evidence of denervation injury to the SUS in women with SUI.

• #89 Urinary Incontinence – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559095/

  Urinary incontinence is the involuntary leakage of urine. This condition is prevalent in older adults but can also affect younger adults and significantly impacts both health and quality of life. The 5 main types include stress, urge, mixed, overflow, and functional incontinence. […] The 5 types of urinary incontinence and their causes are as follows: […] Stress urinary incontinence is the involuntary leakage of urine that occurs with increased intra-abdominal pressure during activities such as exertion, straining, Valsalva, sneezing, or coughing due to the urethral sphincter weakness, pelvic floor weakness, or urethral hypermobility. […] Urge incontinence is the involuntary leakage of urine that may be preceded or accompanied by a sense of urinary urgency (but can be asymptomatic as well) due to detrusor overactivity.

• #90 Urinary Incontinence – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559095/

  Mixed urinary incontinence is the involuntary leakage of urine caused by a combination of stress and urge urinary incontinence, as described above. […] Overflow urinary incontinence is the involuntary leakage of urine from an overdistended bladder due to impaired detrusor contractility and bladder outlet obstruction. […] Functional urinary incontinence is the involuntary leakage of urine due to environmental or physical barriers to toileting. […] Management strategies depend on the type and severity of incontinence, and the patient’s discomfort and morbidity. […] Treatment and management of urinary incontinence depends on its type. Conservative, pharmacologic, and surgical treatment modalities exist. […] Type-specific treatment strategies include the following: […] Stress urinary incontinence: Conservative management includes behavioral therapy, including controlling fluid intake, prompted voiding, bladder training, and constipation management; electrical stimulation; mechanical devices, such as cones, pessaries, and urethral plugs; physical therapy; biofeedback; pelvic floor muscle strengthening, such as Kegel and floor muscle exercises; weight loss; pads, such as diapers; condom catheters; and dietary adjustments, such as eliminating caffeine and other irritants.

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