Urinary incontinence: Difference between revisions
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==Background== | ==Background== | ||
*Defined as the involuntary leakage of urine | |||
*Estimated prevalence of ~40% of women and ~21% of men older than 65 years of age<ref>Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF. The iceberg of health care utilization in women with urinary incontinence. Int Urogynecol J. 2012 Aug;23(8):1087-93. doi: 10.1007/s00192-012-1743-x. Epub 2012 Apr 12. PMID: 22527544; PMCID: PMC3905313.</ref><ref>Shamliyan TA, Wyman JF, Ping R, Wilt TJ, Kane RL. Male urinary incontinence: prevalence, risk factors, and preventive interventions. Rev Urol. 2009 Summer;11(3):145-65. PMID: 19918340; PMCID: PMC2777062.</ref> | |||
*Can have profound impact on quality of life, sexual dysfunction, and morbidity (e.g., perineal infections, falls) | |||
==Clinical Features== | ==Clinical Features== | ||
*Three main classifications of incontinence: Stress, Urgency, Overflow | |||
**Stress: Involuntary leakage of urine that occurs with increases in intraabdominal pressure<ref>Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, Cottenden A, Davila W, de Ridder D, Dmochowski R, Drake M, Dubeau C, Fry C, Hanno P, Smith JH, Herschorn S, Hosker G, Kelleher C, Koelbl H, Khoury S, Madoff R, Milsom I, Moore K, Newman D, Nitti V, Norton C, Nygaard I, Payne C, Smith A, Staskin D, Tekgul S, Thuroff J, Tubaro A, Vodusek D, Wein A, Wyndaele JJ; Members of Committees; Fourth International Consultation on Incontinence. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29(1):213-40. doi: 10.1002/nau.20870. PMID: 20025020.</ref> | |||
**Urgency: Leakage accompanied by or immediately preceded by urgency<ref>Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, Cottenden A, Davila W, de Ridder D, Dmochowski R, Drake M, Dubeau C, Fry C, Hanno P, Smith JH, Herschorn S, Hosker G, Kelleher C, Koelbl H, Khoury S, Madoff R, Milsom I, Moore K, Newman D, Nitti V, Norton C, Nygaard I, Payne C, Smith A, Staskin D, Tekgul S, Thuroff J, Tubaro A, Vodusek D, Wein A, Wyndaele JJ; Members of Committees; Fourth International Consultation on Incontinence. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29(1):213-40. doi: 10.1002/nau.20870. PMID: 20025020.</ref> | |||
**Overflow: Continuous leakage or dribbling in the setting of incomplete bladder emptying | |||
*Mixed urinary incontinence: Symptoms of both stress and urgency | |||
==Differential Diagnosis== | |||
*[[Vaginal atrophy]] | |||
*[[Urinary tract infection]] | |||
*Urogenital fistula | |||
*Neurologic disorders | |||
*Medication toxicity | |||
*[[Constipation]] | |||
===Transient incontinence=== | ===Transient incontinence=== | ||
*[[Delirium]] | *[[Delirium]] | ||
| Line 11: | Line 24: | ||
**[[UTI]] | **[[UTI]] | ||
**[[Loa loa]] | **[[Loa loa]] | ||
*Atrophic vaginitis/urethritis | *[[Atrophic vaginitis]]/[[urethritis]] | ||
*Drugs | *Drugs | ||
**[[Anticholinergics]] | **[[Anticholinergics]] | ||
| Line 35: | Line 48: | ||
==Evaluation== | ==Evaluation== | ||
===Workup=== | |||
*[[Urinalysis]] | |||
*[[Urine culture]] | |||
===Diagnosis=== | |||
*Clinical tests | |||
**Bladder stress test | |||
***PPV is ~78-97% for stress or mixed urinary incontinence<ref>Harvey MA, Versi E. Predictive value of clinical evaluation of stress urinary incontinence: a summary of the published literature. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(1):31-7. doi: 10.1007/s001920170091. PMID: 11294529.</ref> | |||
**Post-void residual: | |||
***>150cc or >1/3 total voided volume should be evaluated for voiding dysfunction | |||
==Management== | ==Management== | ||
| Line 41: | Line 63: | ||
==Disposition== | ==Disposition== | ||
*Discharge with PMD follow-up | |||
*Will rarely require specialist referral | |||
==See Also== | ==See Also== | ||
*[[Urinary incontinence]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Symptoms]] [[Category:Urology]] | |||
Latest revision as of 15:45, 14 December 2022
Background
- Defined as the involuntary leakage of urine
- Estimated prevalence of ~40% of women and ~21% of men older than 65 years of age[1][2]
- Can have profound impact on quality of life, sexual dysfunction, and morbidity (e.g., perineal infections, falls)
Clinical Features
- Three main classifications of incontinence: Stress, Urgency, Overflow
- Mixed urinary incontinence: Symptoms of both stress and urgency
Differential Diagnosis
- Vaginal atrophy
- Urinary tract infection
- Urogenital fistula
- Neurologic disorders
- Medication toxicity
- Constipation
Transient incontinence
- Delirium
- Infection
- Atrophic vaginitis/urethritis
- Drugs
- Psychiatric disorders (e.g. psychosis)
- Polyuria
- Restricted mobility
- Fecal impaction
Established incontinence
- Detrusor overactivity ("urge" incontinence or "overactive" bladder)
- Urethral incompetence (stress incontinence, e.g. multiparity, pelvic surgery)
- Urethral obstruction (e.g. BPH)
- Detrusor underactivity (overflow)
- Spinal cord dysfunction/neurogenic
- Incarcerated uterus
Evaluation
Workup
Diagnosis
- Clinical tests
- Bladder stress test
- PPV is ~78-97% for stress or mixed urinary incontinence[5]
- Post-void residual:
- >150cc or >1/3 total voided volume should be evaluated for voiding dysfunction
- Bladder stress test
Management
Disposition
- Discharge with PMD follow-up
- Will rarely require specialist referral
See Also
External Links
References
- ↑ Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF. The iceberg of health care utilization in women with urinary incontinence. Int Urogynecol J. 2012 Aug;23(8):1087-93. doi: 10.1007/s00192-012-1743-x. Epub 2012 Apr 12. PMID: 22527544; PMCID: PMC3905313.
- ↑ Shamliyan TA, Wyman JF, Ping R, Wilt TJ, Kane RL. Male urinary incontinence: prevalence, risk factors, and preventive interventions. Rev Urol. 2009 Summer;11(3):145-65. PMID: 19918340; PMCID: PMC2777062.
- ↑ Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, Cottenden A, Davila W, de Ridder D, Dmochowski R, Drake M, Dubeau C, Fry C, Hanno P, Smith JH, Herschorn S, Hosker G, Kelleher C, Koelbl H, Khoury S, Madoff R, Milsom I, Moore K, Newman D, Nitti V, Norton C, Nygaard I, Payne C, Smith A, Staskin D, Tekgul S, Thuroff J, Tubaro A, Vodusek D, Wein A, Wyndaele JJ; Members of Committees; Fourth International Consultation on Incontinence. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29(1):213-40. doi: 10.1002/nau.20870. PMID: 20025020.
- ↑ Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, Cottenden A, Davila W, de Ridder D, Dmochowski R, Drake M, Dubeau C, Fry C, Hanno P, Smith JH, Herschorn S, Hosker G, Kelleher C, Koelbl H, Khoury S, Madoff R, Milsom I, Moore K, Newman D, Nitti V, Norton C, Nygaard I, Payne C, Smith A, Staskin D, Tekgul S, Thuroff J, Tubaro A, Vodusek D, Wein A, Wyndaele JJ; Members of Committees; Fourth International Consultation on Incontinence. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29(1):213-40. doi: 10.1002/nau.20870. PMID: 20025020.
- ↑ Harvey MA, Versi E. Predictive value of clinical evaluation of stress urinary incontinence: a summary of the published literature. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(1):31-7. doi: 10.1007/s001920170091. PMID: 11294529.