True incontinence in women

True or total incontinence occurs when the patient has no control over the urinary flow. It is the result of communication between the ureter or bladder and the uterus or vagina.

An acquired fistula is the most common cause, either:

• vesico-vaginal fistula
• uretero-vaginal fistula

Rarely, the cause may be congenital:

• ectopic ureter
• bladder exstrophy

Diagnosis is usually on the basis of painless and continuous vaginal leakage of urine after birth or following pelvic surgery or irradiation.

Surgical repair is indicated in all cases.