Urinary incontinence resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2]


Urinary incontinence is defined as an involuntary leakage of urine. The causes can be temporary or permanent. Most common reversible causes include dementia, delirium, infections, atrophic vaginitis, psychological, drugs, stool impaction. It is broadly classified into 5 types based on the characteristics on the urinary incontinence.


Life Threatening Causes

Common Causes


The approach to the diagnosis of Urinary incontinence is based on a step-wise approach strategy. Below is an algorithm summarising the identification and diagnosis of different types of Urinary incontinence . The algorithm is developed and modified according to American Urological Evaluation (AUA) Guidelines. Shown below is an algorithm summarizing the diagnosis of Urinary incontinence according to The American Urological Association guidelines.

Patients presenting with symptoms of urinary incontinence
Look for temporary causes
  • Dementia, delirium
  • Infections
  • Atrophic vaginitis
  • Psychological
  • Drugs
  • Stool impaction
Look for chronic incontinence
  • History and physical exam including a cough test for stress incontinence
  • Review voiding dairy
  • Do all the lab work
  • Measure post void residual urine volume
Based on all the findings arrive at a diagnosis
"Urge incontinence"
❑ Frequency
❑ Cough stress test: May show delayed leakage after cough
❑ PVR urine< 50ml
❑Variable vol loss seen in voiding dairy
Overflow incontinence
❑No urgency
❑Absence of symptoms on physical activity
❑ Cough stress test:No leakage
❑ PVR urine> 200ml
❑Voiding dairy: varies
Stress incontinence
❑Symptoms seen on coughing, sneezing, exercise, increased intra-abdominal pressure
❑ No nocturia
❑ Cough stress test:Leakage coincides with cough
❑ PVR urine< 50ml
❑Voiding dairy: Small volume leakage
Functional incontinence
❑Cognitive dysfunction, immobility seen
❑ Cough stress test:No leakage
❑ PVR urine: Varies
❑Voiding dairy: Sometimes a pattern seen with incontinence
Mixed incontinence
❑Symptoms with physical activity, urgency noted
❑ Cough stress test:May show leakage
❑ PVR urine<50ml
❑Voiding dairy: Varies


Treatment for different types of urinary incontinence
Stress incontinence
❑Lifestyle modifications like weight loss, smoking cessation, decreasing fluid intake, treating constipation if present
❑Pelvic floor muscle (Kegel) exercises that will strengthen the pelvic floor musculature
❑Supervised pelvic floor therapy
❑Vaginal weighted cones

Urge incontinence
❑behavioral therapy (controlling fluid intake, prompted voiding, constipation management, etc.)
❑Electrical stimulation
❑ Pelvic floor muscle strengthening (Kegel and floor muscle exercises)
❑Weight loss
❑ PVR urine< 50ml
❑Variable vol loss seen in voiding dairy
Overflow incontinence
❑Clean intermittent catheterization
❑Indwelling urethral catheter
❑ Relieving the obstruction
If above modalities failed
Pharmacologic management
❑ Antimuscarinics (e.g., darifenacin, solifenacin, oxybutynin,tolterodine)
❑Topical vaginal estrogen
Pharmacologic management
❑ Alpha-adrenergic antagonists (e.g. terazosin, tamsulosin)

❑Pessaries placement
❑Midurethral sling surgical procedure

❑Surgical management like neuromodulation

❑Surgical management like neuromodulation

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.



  • The content in this section is in bullet points.


  • The content in this section is in bullet points.


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  5. Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE (March 2008). "What type of urinary incontinence does this woman have?". JAMA. 299 (12): 1446–56. doi:10.1001/jama.299.12.1446. PMID 18364487.
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  7. DuBeau CE, Kuchel GA, Johnson T, Palmer MH, Wagg A (2010). "Incontinence in the frail elderly: report from the 4th International Consultation on Incontinence". Neurourol. Urodyn. 29 (1): 165–78. doi:10.1002/nau.20842. PMID 20025027.
  8. "Diagnosis of Urinary Incontinence - American Family Physician".
  9. Frank C, Szlanta A (November 2010). "Office management of urinary incontinence among older patients". Can Fam Physician. 56 (11): 1115–20. PMC 2980426. PMID 21075990.
  10. Imam KA (2004). "The role of the primary care physician in the management of bladder dysfunction". Rev Urol. 6 Suppl 1: S38–44. PMC 1472846. PMID 16985854.

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