3 Physiologic Types: Stress, Urge, Overflow, (also Psychogenic, Functional due to inability to move oneself to toilet, are non-physiologic causes. Mixed also possible of course)
Stress
Cause: Loss of urethral support may cause, or intra-abdominal pressure exceeds (e.g. in pregnancy), urethral sphincter pressure.
Symptoms: Leaking with cough, sneeze, laugh or lifting heavy objects.
Treatment: Kegel exercises to strengthen sphincter muscle, surgery to increase urethral support and thereby decrease pressure on sphincter.
Urge
Cause: Detrusor overactivity, possibly due to M3 overactivity.
Symptoms: Sudden, overwhelming frequent need to empty bladder. Peeing on way to toilet.
Treatment: Phenylephrine, Pseudoephedrine, Adrenergic agonists to counteract muscarinic overactivity.
Overflow
Cause: Impaired detrusor contractility or bladder outlet obstruction due e.g. to BPH.
Symptoms:Constant involuntary dribbling, incomplete emptying.
Treatment: remove the obstruction, increase detrusor contractility with M3 agonists like Bethanechol.
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