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LEARNING OBJECTIVES
Upon completion of the chapter, the reader will be able to:
Explain the pathophysiology of the major types of urinary incontinence (UI): urgency, stress, overflow, and functional.
Recognize the signs and symptoms of the major types of UI in individual patients.
List the treatment goals for a patient with UI.
Compare and contrast available therapeutic agents for UI; identify factors that guide drug selection for an individual patient.
Formulate a monitoring plan and provide patient counseling for a patient on a given treatment regimen based on patient-specific information.
Explain the pathophysiology of pediatric enuresis.
List treatment goals; compare and contrast available management strategies for managing pediatric enuresis.
Formulate a patient-specific monitoring plan and implement patient counseling for a patient on a given treatment regimen.
Describe nonpharmacologic treatment approaches for pediatric enuresis.
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Urinary incontinence (UI) is defined as the complaint of involuntary leakage of urine.1 It is often associated with other bothersome lower urinary tract symptoms such as urgency, increased daytime frequency, and nocturia. Despite its prevalence in both genders, UI remains an underreported health problem that can negatively impact an individual’s quality of life. Patients with UI may sense a loss of self-control, independence, and self-esteem, and often modify their activities for fear of an “accident.” Patients with UI may also suffer from other consequences, including perineal dermatitis and infections, pressure ulcers, urinary tract infections (UTIs), and falls. In the United States, the estimated national cost of urgency urinary incontinence (UUI) in 2007 was $66 billion, with projected costs of $83 billion in 2020.2
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EPIDEMIOLOGY AND ETIOLOGY
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The true prevalence of UI is unclear because of varying definitions of UI and reporting bias.3
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About 44% of noninstitutionalized persons aged 65 and older report UI4
7% to 37% of women aged 20 to 39 report some degree of UI
9% to 39% of women aged 60 and older report daily UI
11% to 34% of older men report some degree of UI
2% to 11% of older men report daily UI
In the noninstitutionalized setting, more than 50% of elderly women and more than 25% of elderly men report UI
46% of short-term and 76% of long-term nursing home residents report UI4
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UI can result from abnormalities within (intrinsic to) and outside of (extrinsic to) the urinary tract. Within the urinary tract, abnormalities may occur in the urethra (including the bladder outlet and urinary sphincters), the bladder, or a combination of both structures. Focusing on abnormalities in these two structures, a simple classification scheme emerges for all but the rarest intrinsic causes of UI. 
Accurate diagnosis and classification of UI type is critical to the selection of appropriate drug therapy.
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Stress Urinary Incontinence
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