Urinary incontinence resident survival guide

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

• Cerebrovascular accident

• Idiopathic parkinson's disease
• Infection
• Limbic encephalitis
• Metastatic prostate cancer
• Mitochondrial parkinson's disease
• Multiple sclerosis
• Parkinson disease
• Pelvic cancer
• Prostate cancer
• Schaefer-stein-oshman syndrome
• Spinal cord neoplasm
• Spinal fracture
• Stroke
• Toxic mushrooms
• Tumor
• Wilms tumor
• Wohlwill-andrade syndrome

Common Causes

• Bladder Cancer
• Botulinum toxin
• Delerium
• Drugs: Bethanechol chloride, Meropenem, Tiagabine
• Infection
• Inflammation
• Multiparity
• Neuropathic bladder dysfunction
• Neurologic
• Obesity
• Obstetric/gynecologic surgery
• Outlet obstruction
• Pelvic surgery
• Polyuria
• Postpartum
• Pregnancy
• Prostate surgery
• Restricted mobility
• Sphincteric atony
• Stool impaction
• Tumor
• Vaginitis
• Vesicovaginal fistula

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

❑Pessaries placement ❑Midurethral sling surgical procedure

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

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