![]() ![]() Inhibit bladder contractions, causing retention and overflow incontinence Inhibit bladder contractions, causing sedation, retention, and overflow incontinenceĪntidepressants, antiparkinsonian agents, antipsychotics Relax the bladder, causing fecal impaction, sedation, retention, and overflow incontinence Increase fluid retention, causing nocturnal diuresis and functional incontinence High urine flow that leads to bladder contractions, causing urge incontinenceĬyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs Relax the bladder, causing retention and overflow incontinence May increase coughing, causing stress incontinence Severe dementia, physical frailty or inability to ambulate, mental health disorder (e.g., depression)ĭecrease sphincter tone, causing stress incontinence Impaired physical function (immobility) and/or impaired cognition ![]() Variable leakage of urine, usually caused by environmental or physical barriers to toiletingĬaused by nongenitourinary factors, such as cognitive or physical impairments that result in the patient's inability to void independently Overdistention of the bladder caused by impaired detrusor contractility or bladder outlet obstruction leads to urine leakage by overflowĭribbling of urine, inability to empty bladder, urinary hesitancy, urine loss without a recognizable urge or sensation of fullness/pressure in lower abdomenĭoes not usually occur unless bladder emptying is poor (postvoid residual volumes > 200 to 300 mL)Īnticholinergic medications, benign prostatic hyperplasia, pelvic organ prolapse, diabetes mellitus, multiple sclerosis, spinal cord injuries Patient should determine which symptom is predominant and most bothersomeĬombination of the etiologies for stress and urge incontinenceĥ percent of patients with chronic incontinence ![]() Involuntary leakage associated with symptoms of urgency loss of urine with exertion, effort, sneezing, or coughing Loss of neurologic control caused by stroke, dementia, spinal cord injury, Parkinson diseaseĢ0 to 30 percent of patients with chronic incontinenceĬombination of stress and urge incontinence Symptoms of urgency may also occur without urinary loss, which is known as overactive bladderīladder irritation caused by cystitis, prostatitis, atrophic vaginitis, bladder diverticuli, prior pelvic radiation therapy Volume of urine loss is variable, ranging from minimal to flooding (if entire bladder volume is emptied) Loss of urine preceded by a sudden and severe desire to pass urine patient typically loses urine on the way to the toiletīladder contractions may also be stimulated by a change in body position (i.e., from supine to upright) or with sensory stimulation (e.g., running water, hand washing, cold weather, arriving at the front door) Patient usually can predict which activities will cause leakageĬhildbirth and obesity in women may occur after prostatectomy in menĭetrusor overactivity (uninhibited bladder contractions) caused by irritation within the bladder or loss of inhibitory neurologic control of bladder contractions Loss of small amount of urine during physical activity or intra-abdominal pressure (coughing, sneezing jumping, lifting, exercise) can occur with minimal activity, such as walking or rising from a chair Sphincter weakness (urethral sphincter and/or pelvic floor weakness) If the type of urinary incontinence is still not clear, or if red flags such as hematuria, obstructive symptoms, or recurrent urinary tract infections are present, referral to a urologist or urogynecologist should be considered.Ģ4 to 45 percent in women older than 30 years Other components of the evaluation include laboratory tests and measurement of postvoid residual urine volume. These determinations are made using a patient questionnaire, such as the 3 Incontinence Questions, an assessment of other medical problems that may contribute to incontinence, a discussion of the effect of symptoms on the patient's quality of life, a review of the patient's completed voiding diary, a physical examination, and, if stress incontinence is suspected, a cough stress test. The next step is to determine the type of incontinence (urge, stress, overflow, mixed, or functional) and the urgency with which it should be treated. If no reversible cause is identified, then the incontinence is considered chronic. The basic workup is aimed at identifying possible reversible causes. The initial evaluation occurs in the family physician's office and generally does not require urologic or gynecologic evaluation. Urinary incontinence is common, increases in prevalence with age, and affects quality of life for men and women. ![]()
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