urinary%20incontinence%20in%20women
URINARY INCONTINENCE IN WOMEN
Treatment Guideline Chart
Urinary incontinence is the complaint of involuntary urine leakage.
Stress urinary incontinence is the involuntary urine leakage on effort or exertion or when coughing or sneezing.
Urge urinary incontinence is the one associated with or immediately preceded by urgency.
Mixed urinary incontinence is the involuntary urine leakage associated with both urgency and with exertion, effort, coughing or sneezing.

Urinary%20incontinence%20in%20women Signs and Symptoms

Definition

  • Urinary incontinence (UI) is defined as complaint of involuntary urine leakage

Major Types of UI

Stress Incontinence 

  • Involuntary urine leakage on effort or exertion, or when coughing or sneezing
  • Occurs during increased intraabdominal pressure that overcomes sphincter mechanism in the absence of bladder contraction
  • Irritative voiding symptoms and nocturia are absent
  • May be caused by poor pelvic support or intrinsic sphincter deficiency
  • Complicated stress UI includes a history of recurrent UTIs, previous pelvic floor repairs, or concurrent urge- or voiding dysfunction-related symptoms

Urge Incontinence 

  • Involuntary urine leakage due to detrusor overactivity (DO), associated with or immediately preceded by urgency
  • Patients are unable to hold back their urine when they feel the intense need to void
  • May be caused by detrusor myopathy, neuropathy, bladder cancer, stones or infections

Mixed Incontinence 

  • Involuntary urine leakage associated with both urgency and with exertion, effort, coughing or sneezing
  • Present when the bladder outlet is weak and detrusor is overactive

Overflow Incontinence 

  • Also referred to as “incomplete emptying”, which describes the dribbling or continuous leakage associated with incomplete bladder emptying
  • May be caused by bladder overdistention, impaired detrusor contraction and/or bladder outlet obstruction
  • Associated symptoms include weak urinary stream, intermittency, hesitancy, frequency and nocturia

Incontinence Related to Reversible Medical Conditions 

  • Transient incontinence
    • Arises from an acute medical condition affecting the lower urinary tract
    • Symptoms resolve when the medical condition is addressed and treated
  • Functional incontinence
    • Arises from chronic impairment of physical and/or cognitive functioning
    • Diagnosis of exclusion
    • Symptoms may resolve by improving patient’s functional status, treating comorbidities and changing medications

Risk Factors

  • Irreversible factors
    • Age, race, family history, childhood enuresis, multiparity, forceps delivery, hysterectomy, surgery for pelvic organ prolapse
  • Reversible factors
    • Body mass index >30, smoking, high caffeine intake, participation in high-impact sports, diabetes, depression, central nervous system (CNS) disorders, recurrent urinary tract infection (UTI), constipation, drugs, pelvic organ prolapse, environmental barriers
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