-History & Physical, see above.
-Different causes of urinary incontinence reviewed w/ patient.
–Treatable causes of urinary incontinence discussed.
-UA, UCx, CBC, CMP. Consider A1C and B12.
-Will Consider U/S to r/o a bladder pathology (diverticulum, mass, etc)
-Will Consider measuring the post-void residual.
–Cough stress-test. A positive cough stress test result is the most reliable clinical assessment for confirming the diagnosis of stress incontinence.
-3-day voiding diary will be reviewed at the next visit.
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“Conservative therapies such as behavioral therapy, including bladder training and lifestyle modification, should be the first-line treatment for both stress and urge urinary incontinence (SOR C). Pharmacologic interventions should be used as an adjunct to behavioral therapies for refractory urge incontinence (SOR C). Vaginal inserts, such as pessaries, can be used for treating stress incontinence but not urge incontinence.” ABFM
Related Links.
- Detrusor Muscle and Urination.
- Treatable Causes of Urinary Incontinence.
- Causes of Urinary Incontinence, DDx.
Cough stress test: You have a patient with a full bladder wear a pad over the perineum and cough. Then the pad is checked for urine.
Types of Incontinence
-Mixed (most common: both stress and urge)
-Stress – Weak sphincter. It’s a muscle dysfunction. Treatment is surgical.
-Urge – Nerve problem. Bladder contracting without brain initiating it. Nerve dysfunction. Sx: -Inability to reach the toilet, urgency, associated with unintentional urine loss.
– Incontinence associated with chronic urinary retention (formerly called overflow incontinence) – Nerve is damaged. Treatment is catheterization.
***The new name for overflow incontinence = incontinence associated with chronic urinary retention.
Flomax – women with urinary retention
Overactive bladder means she has to go very often. She doesn’t leak urine. If she starts leaking urine, it goes from an overactive bladder to urge incontinence.
Overactive bladder and urge incontinence is thus often a continuum.
If they leak urine, it switches from overactive bladder to urge incontinence.
Overactive bladder is not incontinence.
References
Int J Clin Pract. 2011 Oct; 65(10): 1026–1036. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206217/
Am Fam Physician. 2013 Apr 15;87(8):543-550. http://www.aafp.org/afp/2013/0415/p543.html
Am Fam Physician. 2013 May 1;87(9):634-640. http://www.aafp.org/afp/2013/0501/p634.html