Incontinence results when the intravesical pressure exceeds the pressure exerted by the urethral sphincter.
It is probably multifactorial but related largely to nerve damage and/or an alteration in the physiology and structure of the urethral sphincter.
Conventional micturating cystourethrography remains the gold standard for initial evaluation since, unlike indirect isotope cystography, it permits urethral visualisation and grading of reflux.
Caesarean section was associated with a decrease in the internal core of the urethral sphincter but not the rhabdosphincter.
Three had increases in bladder capacity, a fall in bladder pressure at capacity and increase in urethral pressure.
When the urethral atrophy is extensive, the patient may notice an urge sensation.
Other neurological disease, or bladder disease (lithiasis, neoplasia, infection), or bladder-outlet obstruction (prostatic hyperplasia, urethral stenosis) may also be contributory.
If faecal loading and urethral obstruction due to prostatic hypertrophy have been excluded, then use of intermittent catheterization should be considered.
