2026-01-28
| Urinary incontinence refers to the involuntary leakage of urine that constitutes a social and health problem and can be objectively confirmed. The commonly referred to urinary incontinence mainly includes four types: stress, urge, mixed, and overflow. Among them, stress urinary incontinence is the most common type, accounting for approximately 40% to 50%.
Urinary incontinence due to urgency
Urinary incontinence caused by urgency refers to the leakage of urine after a sudden and intense urge to urinate. Pain, discomfort in the lower abdomen, and the perception of a water flow sound can all trigger the urge to urinate in patients. There are mainly three causes: overactivity of the detrusor muscle, poor compliance of the detrusor muscle, and high reactivity of the bladder.
Many patients can monitor spontaneous and uncontrolled contractions of the detrusor muscle during bladder filling, which is called overactivity of the detrusor muscle. These contractions can be consistent with the perceived urgency to urinate. If the pressure generated by these contractions overcomes the resistance of the urethral sphincter, urinary incontinence occurs.
1.Overactive detrusor muscle
The pathophysiological study of overactive detrusor muscle was initially centered on anatomy, known as the neurogenic hypothesis, which posited the loss of inhibition in the central or peripheral nerves, increased afferent impulses in the lower urinary tract, and activation of the excitatory conduction pathways in the bladder reflex, resulting in the blockade of central inhibitory effects. In the early 21st century, many studies focused on the detrusor muscle itself, known as the myogenic hypothesis, which emphasized the changes in the characteristics of the detrusor muscle, leading to excessive excitability and enhanced transmission of excitation between cells, resulting in increased synergistic myogenic contractions. Both myogenic and neurogenic mechanisms can coexist. Such patients often have concurrent urinary system or central nervous system diseases, such as: urethritis, tumors, calculi, diverticula, cystitis, stroke, Parkinson's disease, spinal cord injury, etc.
2. Detrusor Hypo-Relaxation
For patients undergoing radiotherapy, those with chronic infections or those who have undergone long-term catheterization, the urge to urinate or the pain is often due to bladder fibrosis. The bladder wall becomes hard and its compliance decreases, resulting in an inability of the bladder pressure to adapt to the gradually increasing urine volume, which leads to the occurrence of urinary incontinence.
3. Bladder hyperreactivity
The epithelium of the lower urinary tract not only closes the urethra but also is a sensitive structure that can sense temperature, mechanical force and chemical stimuli. The transmission of sensory information from the bladder is considered a key factor in overactive bladder. Due to excessive sensitivity of the urethra or bladder, the bladder experiences a strong urge to urinate even with a small amount of urine, and sometimes there is a persistent urge to urinate. This sensation may disappear after urination or may not disappear. Causes that can lead to enhanced bladder sensation include urethritis, acute and chronic cystitis, interstitial cystitis, bladder stones or tumors, etc.
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