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: Mahmoud Sakr, M.D. [2]

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

Common Causes

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Urinary incontinence according the the [...] 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"
❑Urgency
❑ Frequency
❑Nocturia
❑ 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

 
 
 
 
 
 
 
 
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
❑Biofeedback

 
"Urge incontinence"
❑Urgency
❑ Frequency
❑Nocturia
❑ Cough stress test: May show delayed leakage after cough
❑ PVR urine< 50ml
❑Variable vol loss seen in voiding dairy
 
D03
 
D04
 
D05
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If above modalities failed
 
 
 
 
 
 
 
 
 
 
 
 
 
E02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
E02


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

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

  • The content in this section is in bullet points.

Don'ts

  • The content in this section is in bullet points.

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  3. "pdfs.semanticscholar.org" (PDF).
  4. Brown JS, Bradley CS, Subak LL, Richter HE, Kraus SR, Brubaker L, Lin F, Vittinghoff E, Grady D (May 2006). "The sensitivity and specificity of a simple test to distinguish between urge and stress urinary incontinence". Ann. Intern. Med. 144 (10): 715–23. PMC 1557357. PMID 16702587.
  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.
  6. Videla FL, Wall LL (June 1998). "Stress incontinence diagnosed without multichannel urodynamic studies". Obstet Gynecol. 91 (6): 965–8. PMID 9611005.
  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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