Chapter 27: Disorders of the Bladder and Lower Urinary Tract-Patho Level 3

A patient is describing difficulty with urinating and informs the nurse that every time she coughs or laughs, she urinates and has begun to wear a thin pad. Which of the following types of urinary incontinence is the patient describing? a) Stress incontinence b) Urge incontinence c) Functional incontinence d) Overflow

Stress incontinence Stress incontinence is the loss of urine associated with activities, such as coughing, that increase intra-abdominal pressure. Overactive bladder/urge incontinence is urgency and frequency associated with hyperactivity of the detrusor muscle may or may not involve involuntary loss of urine. Overflow is the involuntary loss of urine when intravesicular pressure exceeds maximal urethral pressure in the absence of detrusor activity. Functional incontinence is a lack of cognitive function to go to the bathroom, commode, or urinal/bedpan resulting in spontaneous urination.

Because they strengthen the pelvic floor muscles, Kegel exercises are most likely to help: a) Mixed incontinence b) Overflow incontinence c) Stress incontinence d) Urge incontinence

Stress incontinence Correct Explanation: Stress incontinence is commonly caused by weak pelvic floor muscles, which allow the angle between the bladder and the posterior proximal urethra to change so that the bladder and urethra are positioned for voiding when some activity increases intra-abdominal pressure. Overflow incontinence results when the bladder becomes distended and detrusor activity is absent. Urge incontinence is probably related to CNS control of bladder sensation and emptying or to the smooth muscle of the bladder. Mixed incontinence, a combination of stress and urge incontinence, probably has more than one cause.

A nurse is caring for a client who has just experienced a spinal cord injury. Which of the following bladder dysfunctions will the client experience? a) The bladder become hyperactive. b) Internal sphincter contracts. c) External sphincter relaxes. d) The bladder becomes atonic.

The bladder becomes atonic. The immediate and early effects of spinal cord injury on bladder function are quite different from those that follow recovery from the initial injury. During the period immediately after spinal cord injury, a state of spinal shock develops in which all reflexes, including the micturition reflex, are depressed. During this stage, the bladder becomes atonic and cannot contract. Catheterization is necessary to prevent injury to urinary structures associated with overdistention of the bladder. Depression of reflexes lasts from a few weeks to 6 months (usually 2 to 3 months), after which the spinal reflexes return and become hyperactive

The nursing instructor, while teaching about incontinence in older adults, informs the students that which of the following is true? a) Urinary incontinence is a problem found only in the older adult population. b) Urinary incontinence is a common problem in older adults, both male and female. c) Urinary incontinence is found only in males as they age. d) Urinary incontinence is found only in females as they age.

Urinary incontinence is a common problem in older adults, both male and female. Urinary incontinence is a common problem in older adults both male and female. It can also occur at an earlier age in both sexes.

The nursing instructor who is teaching about disorders of the lower urinary tract realizes a need for further instruction when one of the students makes which of the following statements? a) "Alterations in bladder function can include urinary obstruction with retention or stasis of urine." b) "Alterations in bladder function occurs frequently in the elderly." c) "Alterations in bladder function can only occur when there is incontinence." d) "Alterations in bladder function can include urinary incontinence with involuntary loss of urine."

"Alterations in bladder function can only occur when there is incontinence." Correct Explanation: Alterations in bladder function include urinary obstruction with retention or stasis of urine and urinary incontinence with involuntary loss of urine. Alterations in bladder function does occur more frequently with aging.

The nurse is scheduled to teach a client experiencing urinary incontinence about Kegel exercises. Which of the following descriptors should the nurse include in this education? a) "After you have emptied your bladder, continue sitting on the commode and try to forcefully expel more urine." b) "Contract and relax the pelvic floor muscles at least 10 times every hour while awake." c) "Drink at least two glasses of water and then try to hold it for at least 3 hours before going to the bathroom." d) "Try to start and stop urination while sitting in a bathtub full of warm soapy water."

"Contract and relax the pelvic floor muscles at least 10 times every hour while awake." Correct Explanation: Exercises for the pelvic muscles or Kegel exercises involve repetitive contraction and relaxation of the pelvic floor muscles and are an essential component of client-dependent behavioral interventions. None of the other distractors are examples of Kegel exercises.

A client who has had recurrent UTIs asks the nurse about the old wise tale of drinking cranberry juice daily. The nurse can respond: a) "There is no research on this topic, so I don't think it will help you." b) "Studies on this are based on a person drinking at least 1 gallon of juice/day." c) "Research suggests cranberry juice will reduce bacterial adherence to the lining of the urinary tract." d) "Beer is probably more effective at killing bacteria than cranberry juice."

"Research suggests cranberry juice will reduce bacterial adherence to the lining of the urinary tract." Correct Explanation: Cranberry juice or blueberry juice has been suggested as a preventive measure for persons with frequent UTIs. Studies suggest that these juices reduce bacterial adherence to the epithelial lining of the urinary tract.

The client has just been diagnosed with bladder cancer and asks the nurse what causes it. Which of the following would be the nurse's best response to the client? a) "The cause is unknown." b) "It is usually inherited." c) "It is due to something outside the body." d) "You should not worry about its cause."

"The cause is unknown." The nurse should tell the patient that the cause of bladder cancer is unknown; however, evidence suggests that its origin is due to local influences such as carcinogens that are excreted in the urine and stored in the bladder. It is not inherited and it would not be therapeutic to tell the patient not to be concerned about its cause.

A bladder cancer client asks the nurse, "What did the doctor mean by intravesicular chemotherapy? Am I going to lose all my hair and have to do for treatments over months and months?" The best response would be: a) "This is when they use a CyberKnife to cut off any lesions and then inject chemotherapy into the remaining portion of the bladder." b) "They will take you to radiology and inject some chemotherapy through your abdomen into your bladder." c) "The doctor will place a scope up your urethra, into the bladder, and burn the lining of the bladder with a laser and then inject some tuberculosis bacillus into the lining." d) "This is when they put the chemotherapy directly into the bladder to kill any cancer cells."

"This is when they put the chemotherapy directly into the bladder to kill any cancer cells." Correct Explanation: Surgical treatment of superficial bladder cancer is often followed by intravesicular chemotherapy or immunotherapy, a procedure in which the therapeutic agent is directly instilled into the bladder. None of the other responses describe this procedure. The chemotherapy drug is not injected through the abdomen into the bladder. BCG is instilled into the bladder to elicit an inflammatory response that can kill the tumor. A CyberKnife is used with the brain, not the bladder

A patient has a postvoid residual (PVR) volume of 250 mL. Which of the following information would the nurse tell the patient? a) "This test indicates you do not have adequate bladder control." b) "This value indicates you are emptying your bladder too completely." c) "This value indicates you are having difficulty emptying your bladder." d) "This is a normal value."

"This value indicates you are having difficulty emptying your bladder." Correct Explanation: The nurse should inform the client that values over 200 mL indicate that the patient is not able to adequately empty the bladder and that further evaluation is necessary. It is not a normal value, nor does it indicate that the patient does or does not have adequate bladder control. (

Which of the following types of pharmacological therapy does the nurse anticipate administering to a patient for treatment of a spastic bladder in order to decrease bladder hyperactivity? a) Calcium channel blockers b) Antibiotics c) Biofeedback d) Anticholinergic medications

Anticholinergic medications Correct Explanation: Among the methods used to treat spastic bladder and detrusor-sphincter dyssynergia are the administration of anticholinergic medications to decrease bladder hyperactivity and urinary catheterization to produce bladder emptying. Antibiotics are used to treat urinary tract infections. Biofeedback is a behavioral method of treatment. Calcium channel blockers would not be effective in treating this disorder.

What is the most common gram-negative bladder infection found in hospitalized clients? a) Stone formation b) Catheter-induced infection c) Neurogenic bladder d) Urinary incontinence

Catheter-induced infection Correct Explanation: Urinary catheters are a source of urethral irritation and provide a means for entry of microorganisms into the urinary tract. Catheter-associated bacteriuria remains the most frequent cause of gram-negative septicemia in hospitalized clients. Studies have shown that bacteria adhere to the surface of the catheter and initiate the growth of a biofilm that then covers the surface of the catheter.

Which physiologic change in the elderly population contributes to urinary incontinence? a) Increased bladder contractility b) Side effects of medication c) Decline in detrusor muscle function d) Increased bladder capacity

Decline in detrusor muscle function Correct Explanation: In the elderly population, overall bladder capacity is reduced as is urethral closing pressure. Changes associated with aging include decline in detrusor muscle function, decrease in bladder contraction, and impairment in bladder emptying. Medications may contribute to incontinence; however, it is not a physiologic change; it is a chemical influence.

While studying about the process of urination, the nursing student learns that which of the following is known as the "muscle of micturition"? a) Trigone muscle b) External sphincter muscle c) Internal sphincter muscle d) Detrusor muscle

Detrusor muscle Explanation: The detrusor muscle is the uncle of micturition. In the bladder neck is the continuation of the detrusor muscle known as the internal urethral sphincter, which acts as a sphincter when closed. The external sphincter muscle surrounds the urethra distal to the base of the bladder. There is not a trigone muscle; the trigone is the smooth triangular area that is bounded by the openings for the both ureters and the urethra.

Which of the following is the most common cause of lower uncomplicated urinary tract infections? a) H. pylori b) Proteus amoeba c) Escherichia coli d) Helicobacter

Escherichia coli Correct Explanation: Most uncomplicated lower UTIs are caused by Escherichia coli. Other common uropathic pathogens include Enterococcus faecalis, Staphylococcus saprophyticus, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas species. Helicobacter, H. pylori, and Proteus amoeba do not cause UTIs.

The patient who has been admitted with a problem with his bladder has a postvoid residual (PVR) of 250 ml. The nurse understands that this indicates which of the following? a) Inadequate bladder emptying b) Adequate bladder emptying c) No problem at all d) A problem with storage of urine

Inadequate bladder emptying Correct Explanation: Postvoid residual (PVR) urine volume provides information about bladder emptying and NOT storage. A PVR value of less than 50ml is considered adequate bladder emptying and more than 200 ml indicates inadequate bladder emptying.

A client reports that she A client reports that she frequently suffers from UTIs after engaging in sexual intercourse. Which would be the best information for the nurse to provide? a) Refrain from intercourse b) Delay voiding for 5 hours after intercourse c) Decrease fluid intake before intercourse d) Increase fluid intake before intercourse

Increase fluid intake before intercourse Correct Explanation: A nonpharmacologic approach to the treatment of frequent UTIs associated with sexual intercourse is to increase fluid intake before intercourse and to void soon after intercourse. This procedure uses the washout phenomenon to remove bacteria from the bladder.

A female client asks the nurse if there is any noninvasive treatment to help with the involuntary loss of urine that occurs when she coughs or sneezes. Which is the best response by the nurse? a) Self-catheterization b) Periurethral injection of a bulking agent c) Implanted artificial sphincter d) Kegel exercises

Kegel exercises Kegel exercise involves repetitive contraction and relaxation of the pelvic floor muscles and is a noninvasive way of strengthening the pelvic floor muscles and is a client-dependent behavioral intervention. The remaining options are invasive procedures.

A patient is concerned about the possibility of having bladder cancer after his brother was diagnosed with it 2 years ago. Which of the following assessment data obtained by the nurse would indicate that the patient should be screened for this disease? a) Patient reports diminished stream. b) Patient reports pain when he urinates. c) Patient reports that his urine has a foul smell and it is cloudy. d) Patient reports that he occasionally has blood in his urine but has no pain with it.

Patient reports that he occasionally has blood in his urine but has no pain with it. Explanation: The most common sign of bladder cancer is painless hematuria. Gross hematuria is a presenting sign in the majority of people with the disease, and microscopic hematuria is present in most others. Frequency, urgency, and dysuria occasionally accompany the hematuria. Because hematuria is often intermittent, the diagnosis may be delayed.

A nurse is caring for a patient in spinal shock. Which of the following interventions is appropriate in relation to the patient's urinary status? a) Assess bowel sounds b) Perform a urine culture c) Perform intermittent catheterization d) Palpate the lower abdomen

Perform intermittent catheterization After a spinal cord injury, the early effects on bladder function are quite different from those that follow recovery from the initial injury. During the period immediately after spinal cord injury, a state of spinal shock develops, during which all the reflexes, including the micturition reflex, are depressed. The bladder is atonic and cannot contract. Intermittent catheterization is necessary to prevent injury to urinary structures associated with overdistension of the bladder.

A client who is admitted to the hospital receives a diagnosis of lower urinary tract obstruction. What does the nurse pick to be the immediate treatment for this problem? a) Bladder training b) Pain med c) Correcting the problem causing the obstruction d) Relief of bladder distention

Relief of bladder distention The immediate treatment of lower urinary tract obstruction and stasis is directed toward relief of bladder distention, which is usually accomplished through catheterization. Correcting the problem that is the cause is a long-term treatment. Pain med does not help the problem, nor does bladder training.

A client who has a problem with incontinence loses a small amount of urine every time she coughs or sneezes. This type of incontinence is known as which of the following? a) Urge b) Functional c) Overflow d) Stress

Stress Stress incontinence is the involuntary loss of urine associated with activities such as coughing and sneezing. Urge incontinence is the urgency and frequency associated with hyperactivity of the detrusor muscle. Overflow incontinence is the involuntary loss of urine when intravesicular pressure exceeds maximal urethral pressure. Functional incontinence is the lack of cognitive function to go to the bathroom.

A 61 year-old woman who has had an upper respiratory infection for several weeks has presented to her family physician with complaints of a recent onset of urinary retention. She reveals to her physician that she has been taking non-prescription cold medications over and above the suggested dose for the past two weeks. Which of the following phenomena will her physician most likely suspect is contributing to her urinary retention? a) Antihistamine effects inhibit communication between the pons and the thoracolumbar cord. b) The anticholinergic effects of the medication are impairing normal bladder function. c) Cholinergic actions of the cold medicine are triggering internal and external sphincter contraction. d) Over-the-counter medications such as cold medicine stimulate the parasympathetic nervous system and inhibit bladder emptying.

The anticholinergic effects of the medication are impairing normal bladder function. Many over-the-counter cold medications have an anticholinergic effect that interferes with normal bladder emptying. These effects on micturition are not a result of cholinergic actions or miscommunication between the pontine micturition center and the spinal cord. Stimulation of the parasympathetic nervous system would tend to increase rather than decrease bladder emptying.

Which of the following patients should have a feeling of bladder fullness? a) The patient with 200 mL of urine in their bladder b) The patient who has neuropathy c) The patient who is incontinent d) The patient with 25 mL of urine in their bladder

The patient with 200 mL of urine in their bladder Explanation: In a normally functioning bladder, the sensation of bladder fullness is first perceived when the bladder contains 100-200 mL of urine. The patient who has neuropathy or is incontinent may not have a feeling of bladder fullness.

The nursing student, while studying anatomy and physiology, correctly identifies which of the following to be responsible for carrying urine to the bladder? a) Ureters b) Bowman's capsule c) External sphincter d) Trigone

Ureters Correct Explanation: Urine passes from the kidneys to the bladder through the ureters. The bowman's capsule is a component of the kidney. The external sphincter serves as a reserve mechanism to stop micturition when it is occurring, while the trigone is the smooth triangular area that is bounded by the openings of the ureters and the urethra.

The nurse understands that medications although very beneficial to clients can also have harmful effects. When working with elderly clients the nurse should recognize which of the following is a common result of potent, fast-acting diuretics? a) Decreased urine output b) Increased potassium levels c) No untoward effects d) Urge incontinence

Urge incontinence Medications prescribed for other health problems may prevent a healthy bladder from functioning properly. Potent, fast-acting diuretics are known for their ability to cause urge incontinence. They can decrease potassium levels and increase urine output. They do have untoward effects

A patient is admitted with lower urinary tract obstruction and stasis. Which of the following is the primary intervention? a) Laxative administration b) Administration of intravenous fluids c) Urinary catheterization d) Increased oral fluids

Urinary catheterization Explanation: The relief of lower urinary tract obstruction is directed toward relief of bladder distension through urinary catheterization. This is the primary intervention. The other interventions are not the priority.

When teaching a community education class about the 7 warning signs of cancer, the nurse will note that the most common sign of bladder cancer is: a) Inability to empty the bladder fully. b) Painless bloody urine. c) Passage of large clots after voiding. d) Colic spasms of the ureters.

Urinary catheters are a source of urethral irritation and provide a means for entry of microorganisms into the urinary tract. Catheter-associated bacteriuria remains the most frequent cause of gram-negative septicemia in hospitalized clients. Studies have shown that bacteria adhere to the surface of the catheter and initiate the growth of a biofilm that then covers the surface of the catheter.

A female teenager has experienced three uncomplicated urinary tract infections in the last 3 months. Knowing the anatomical location of the urethra, the nurse should educate this teenager about: a) Wearing gloves when wiping perineum after defecation to prevent Staphylococcus aureus infection b) Proper handwashing to decrease amount of Pseudomonas growing on the hands c) Wiping from front to back to preventEscherichia coli contamination of the urethra d) Washing hands prior to inserting a tampon to minimize the risk of group B Streptococcus

Wiping from front to back to preventEscherichia coli contamination of the urethra Correct Explanation: Most commonly, urinary tract infections (UTIs) are caused by Escherichia coli that enter through the urethra. Escherichia coli are abundant in fecal matter. Other uropathic pathogens include Staphylococcus saprophyticus in uncomplicated UTIs and both non-E. coli gram-negative rods (Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas) and gram-positive cocci (Staphylococcus aureus, group B Streptococcus) in complicated UTIs.

A client who is having problems with his bladder and kidneys is scheduled for a cystoscopy. He asks the nurse why he has to have the test. Which of the following would be the best response by the nurse? a) "A cystoscopy provides information about the flow rate during urination." b) "A cystoscopy can estimate bladder volume." c) "A cystoscopy enables direct visualization of the urethra, bladder and ureteral orifices." d) "A cystoscopy provides information about bladder emptying."

• "A cystoscopy enables direct visualization of the urethra, bladder and ureteral orifices." A cystoscopy enables direct visualization of the urethra, bladder and ureteral orifices. A bladder scan provides method for estimating volume and a PVR provides information bout bladder emptying. Flow rate is determined by doing uroflowmetry

An elderly woman comes to the hospital and is diagnosed with urinary obstruction and retention. Which of the following symptoms would the nurse expect this client to demonstrate? Select all that apply. a) Strong stream b) Frequency c) Overflow incontinence d) Hesitancy e) Nladder distention

• Bladder distention • Hesitancy • Frequency • Overflow incontinence Signs of outflow obstruction and urine retention are: bladder distention, hesitancy, straining when initiating urination, small and weak stream, frequency, feeling of incomplete bladder emptying and overflow incontinence. A strong stream is not a symptom.

When conducting an admission interview with a client with a history of urinary incontinence, the nurse will specifically ask whether the client is prescribed which classification of medications in order to determine a possible cause? Select all that apply. a) Tricyclic antidepressants b) Sedatives c) Diuretics d) Hypnotics e) Acetylcholines

• Diuretics • Hypnotics • Sedatives Medication prescribed for other health problems may prevent a healthy bladder from functioning normally. Drugs such as hypnotics, tranquilizers, and sedatives can interfere with the conscious inhibition of voiding, leading to urge incontinence. Diuretics, particularly in older adults, increase the flow of urine and may contribute to incontinence, particularly in people with diminished bladder capacity and in those who have difficulty reaching the toilet. Acetylcholines and tricyclic antidepressants are sometimes used to treat specific types of incontinence.

The nursing students have learned in class that causes of urinary obstruction and urinary incontinence include which of the following? Select all that apply. a) Structural changes in the pancreas b) Impairment of neurologic control of bladder function c) Structural changes of the gallbladder d) Structural changes in the urethra e) Structural changes in the bladder

• Impairment of neurologic control of bladder function • Structural changes in the urethra • Structural changes in the bladder Correct Explanation: Urinary obstruction and urinary incontinence can be caused by several factors, including structural changes in the bladder, structural changes in the urethra, and impairment of neurologic control of bladder function. Changes in the gallbladder or pancreas do not cause urinary obstruction or incontinence.

An adult client presents to the emergency department with manifestations of acute cystitis. For which would the nurse assess the client? Select all that apply. a) Urinary infrequency b) Burning on urination c) Chest pain d) Fever e) Cloudy urine f) Back discomfort

• Burning on urination • Cloudy urine • Back discomfort An acute episode of cystitis (bladder infection) is characterized by frequency of urination, lower abdominal or back discomfort, and burning and pain on urination (i.e., dysuria). Occasionally, the urine is cloudy and foul smelling. In adults, fever and other signs of infection usually are absent. If there are no complications, the symptoms disappear within 48 hours of treatment.

A client who is experiencing bladder overfilling will more than likely have which of the following disease? Select all that apply. a) Diabetic neuropathies b) Multiple sclerosis c) Parkinson's disease d) Spinal cord injury e) Stroke

• Diabetic neuropathies • Multiple sclerosis Explanation: Common causes of bladder overfilling that lead to a loss of ability to perceive bladder filling are diabetic neuropathies and multiple sclerosis. Spinal cord injury results in a loss of external sphincter tone or areflexic bladder where it fills but not contract. Parkinson's causes detrusor contractions suddenly without warning and are difficult to control while a stroke causes a loss of ability to perceive bladder filling.

Which of the following individuals are displaying identified risk factors for the development of lower urinary tract obstruction? Select all that apply. a) 68 year-old man who has been diagnosed with benign prostatic hyperplasia (BPH). b) 20 year-old man who has spina bifida and consequent impaired mobility. c) 74 year-old woman who has developed a lower bowel obstruction following several weeks of chronic constipation. d) 55 year-old man with diabetes who is receiving diuretic medications for the treatment of hypertension. e) 32 year-old woman who had a healthy delivery of her third child 4 months ago. f) 30 year-old woman who has been diagnosed with gonorrhea.

• 68 year-old man who has been diagnosed with benign prostatic hyperplasia (BPH). • 30 year-old woman who has been diagnosed with gonorrhea. • 74 year-old woman who has developed a lower bowel obstruction following several weeks of chronic constipation. • 20 year-old man who has spina bifida and consequent impaired mobility. Explanation: BPH frequently obstructs the urethra, while sexually transmitted diseases, bowel obstructions and spina bifida are also associated with physical blockages of the lower urinary tract. Postpartum women and individuals receiving diuretics would be more likely to be at risk for incontinence rather than urinary retention.

An elderly client has just been admitted for urinary tract obstruction and retention. Which of the following are symptoms that the nurse should suspect this client to demonstrate? Select all that apply. a) Hesitancy b) Bladder distention c) Small stream d) Forceful stream e) Overflow incontinence

• Bladder distention • Hesitancy • Small stream • Overflow incontinence Signs of outflow obstruction and urine retention are bladder distention, hesitancy, straining when initiating urination, small and weak stream, frequency, feeling of incomplete bladder emptying, and overflow incontinence

A patient with stress incontinence states, "every time I laugh or cough, I urinate on myself. Which of the following behavioral measures would be beneficial for the nurse to teach the patient? a) Administration of tricyclic antidepressants b) Care of an indwelling Foley catheter c) Kegel exercises d) Administration of anticholinergic medications

Kegel exercises Behavioral methods for incontinence include fluid management, timed/prompted voiding, pelvic floor exercises (Kegel exercises), bladder retraining, and toileting assistance. Bladder retraining and biofeedback techniques seek to reestablish cortical control over bladder function by having the person ignore urgency and respond only to cortical signals during waking hours. Indwelling catheters are not used routinely to control incontinence and is a medical intervention. Administering medications is considered to be a pharmacological intervention.

An 87 year-old male resident of an assisted living facility has been consistently continent of urine until the last several weeks. Which of the following actions by the care providers at the facility is the most likely priority? a) Providing client education focusing on the fact that occasional incontinence is a normal, age-related change. b) Performing a physical examination and history to determine the exact cause and character of the incontinence. c) Teaching the resident about protective pads, collection devices and medications that may be effective. d) Showing the resident the correct technique for exercises to improve bladder, sphincter and pelvic floor tone.

Performing a physical examination and history to determine the exact cause and character of the incontinence. The priority in the treatment of incontinence in the elderly is an acknowledgement that it is not an inevitability and that the exact causes should and most often can be identified. This identification by way of history-taking and examination would supersede teaching about protective devices or exercises

A female client asks, "Why do I leak urine every time I cough or sneeze?" The health care worker's response is based on which physiologic principle? a) When intravesical pressure exceeds maximal urethral closure pressure b) Involuntary bladder continence during filling c) A decrease in bladder distensibility d) A pressure difference between the urethra and bladder

When intravesical pressure exceeds maximal urethral closure pressure Correct Explanation: Stress incontinence represents the involuntary loss of urine that occurs when, in the absence of detrusor muscle action, the intravesical pressure exceeds the maximum urethral closure pressure. Stress incontinence, which is a common problem in women of all ages, occurs as the result of weakness or disruption of pelvic floor muscles, leading to poor support of the vesicourethral sphincters. Except during the act of micturition, intraurethral pressure is normally greater than intravesical pressure. Urge incontinence and overactive bladder are associated with urgency caused by bladder infection or CNS or myogenic mechanisms. Overflow incontinence is an involuntary loss of urine that occurs when intravesical pressure exceeds the maximal urethral pressure because of bladder distention in the absence of detrusor activity