Causes of Established Incontinence

Bladder outlet incompetence

Lower motor neuron lesion (rare)

In men, radical prostatectomy*

Intrinsic sphincter deficiency

Urethral hypermobility

In women, multiple vaginal deliveries, pelvic surgery (eg, hysterectomy), age-related changes (eg, atrophic urethritis)

In men, prostate surgery

Bladder outlet obstruction

Spinal cord lesion causing detrusor-sphincter dyssynergia (rare)

Anterior urethral stricture

Urethral diverticula (rarely) or large bladder diverticula (very rarely)

Bladder neck suspension surgery

In women, cystocele (if large)

In men, benign prostatic hyperplasia or prostate cancer

Detrusor overactivity

Alzheimer disease or other dementias

Spinal cord injury/dysfunction

Multiple sclerosis

Stroke

Bladder carcinoma

Idiopathic

Outlet obstruction or incompetence

Detrusor underactivity

Autonomic neuropathy (eg, due to diabetes, alcoholism, or vitamin B12 deficiency)

Disc compression

Plexopathy disc herniation

Spinal neural tube defect (less often, may cause overactivity)

Surgical damage (eg, anteroposterior resection for rectal cancer)

Tumor

Chronic bladder outlet obstruction

Idiopathic (common among women)

Detrusor-sphincter dyssynergia

Spinal cord lesion

Brain lesion affecting pathways to the pontine micturition center

Voiding dysfunction of childhood (poor relaxation of the sphincter with bladder contraction can result from the fear of bed wetting or soiling of clothes)