Urinary incontinence: Pathology review
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Urinary incontinence: Pathology review
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Urinary incontinence: Pathology review
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Assessments
Urinary incontinence: Pathology review
USMLE® Step 1 questions
0 / 3 complete
Questions
USMLE® Step 1 style questions USMLE
of complete
| Laboratory value | Result |
| Glucose | 118 mg/dL |
| HbA1c | 6.9% |
| Prostate-specific antigen (PSA)* | 3.6 ng/ml |
Which of the following is the most likely cause of the patient’s urinary symptoms?
Transcript
Contributors
Anca-Elena Stefan, MD
Evan Debevec-McKenney
Marisa Pedron
Elizabeth Nixon-Shapiro, MSMI, CMI
In the Urology ward, two people are coming in. The first is Oleg, a 70 year old man who says that he frequently has to use the bathroom and also complains of a weak urinary stream. The second is Samantha, a 55 year old woman who says that she “pees” a little when she laughs. Samantha also has 2 children and both were born by vaginal delivery. Now, both these individuals seem to have urinary incontinence.
Urinary incontinence is a problem where the process of urination happens involuntarily, meaning that a person might urinate without intending to. This is particularly problematic because it affects a person’s personal hygiene as well as their social life in a way that can be very limiting.
Let’s talk about physiology real quick. Okay, so as urine flows from the kidneys into the bladder, the bladder starts to fill. Lining the bladder is a layer of transitional epithelium containing “umbrella cells”. These cells physically stretch out as the bladder fills, just like an umbrella opening up in slow-motion. This expansion is further aided by the relaxation of the muscular layer within the bladder’s walls, called the detrusor muscle. At some point, the bladder fills up with urine that will eventually exit the body through the urethra.
Now, the urethra is wrapped up in some muscles that can prevent urine from leaking out. The first one is the internal sphincter muscle, which is made of smooth muscle and is under involuntary control and typically opens up when the bladder is about half full. The second one is the external sphincter muscle, and it’s made of skeletal muscle and is under voluntary control. This is the reason that it’s possible to stop urine mid-stream by tightening up that muscle. Once urine has passed through the external sphincter muscle, it can no longer be stopped.
Summary
Urinary incontinence is a common condition that occurs when urine involuntarily leaks from the bladder, often through the internal and external sphincter muscles. There are several types of urinary incontinence, including urge incontinence, stress incontinence, and overflow incontinence.
Urge incontinence is typically caused by an overactive bladder, which can lead to sudden and strong urges to urinate that are difficult to control. Stress incontinence, on the other hand, is often due to increased pressure on the bladder, which can happen during physical activity, sneezing, or coughing. Overflow incontinence is caused by incomplete emptying of the bladder, leading to urine leakage due to bladder overfilling.
The treatment for urinary incontinence depends on the underlying cause and severity of the condition. Some common interventions include strengthening the external sphincter muscle by doing things like Kegel exercises, and catheterization or medications like alpha-blockers, which relax the smooth muscle to assist with urination.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "First Aid for the USMLE Step 1 2018, 28th Edition" McGraw-Hill Education / Medical (2017)
- "Effectiveness of preoperative pelvic floor muscle training for urinary incontinence after radical prostatectomy: a meta-analysis" BMC Urology (2014)
- "Prevalence of postpartum urinary incontinence: a systematic review" Acta Obstetricia et Gynecologica Scandinavica (2010)
- "Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment" International Urogynecology Journal (2013)
- "Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice Guideline From the American College of Physicians" Annals of Internal Medicine (2014)
- "Benefits and Harms of Pharmacologic Treatment for Urinary Incontinence in Women" Annals of Internal Medicine (2012)
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