**1.3. Urinary incontinence**

Urinary incontinence is an extremely common complaint worldwide. It causes a great deal of distress and embarrassment, as well as significant costs, to both individuals and societies (Lucas, Bosch et al. 2012). The standardization committee of the International Continence Society (ICS) has defined the female urinary incontinence as the involuntary urine loss, objectively demonstrable, which represents a social or hygienic problem (Abrahams, Blaivas et al. 1988).

At least one out of four women in Europe suffers from a disorder associate with incontinence which often has been present for several years before consultation (Thomas, Plymat et al. 1980). In geriatric hospitals, the incidence of urinary incontinence I in women is 43% and as high as n 91% in psychogeriatric patients.

Patients with 'complicated incontinence' are those with co-morbidities, a history of previous pelvic surgery, past surgery for incontinence, radiotherapy and associated genitourinary prolapse (Lucas, Bosch et al. 2012). Urinary incontinence is more common in women with UTIs and is also more likely in the first few days following an acute infection (Moore, Jackson et al. 2008).

In women with incontinence, diagnosis of a UTI by positive leucocytes or nitrites using urine test strips had low sensitivity but high specificity (Semeniuk and Church 1999; Buchsbaum, Albushies et al. 2004).

Incontinent women with symptoms of lower urinary tract or pelvic floor dysfunction and pelvic organ prolapse have a higher risk of of incomplete bladder emptying (elevated post void residual urine volume) compared to asymptomatic patients. Therefore it is suggested that the presence of post void residual should be ruled out in this patients (Fowler, Panicker et al. 2009).

In the elderly incontinence can be caused or worsened by underlying diseases including diabetes (Lee, Cigolle et al. 2009). A higher prevalence of incontinence was associated with higher age and body mass index (Sarma, Kanaya et al. 2009). A recent meta-analysis showed that systemic oestrogen therapy for post-menopausal women was associated with the devel‐ opment and worsening of urinary incontience (Cody, Richardson et al. 2009). Obesity appears to confer a four-fold increased risk of UI (Chen, Gatmaitan et al. 2009).
