Urinary incontinence is any involuntary leakage of urine, and it is common in women and older adults but never a normal part of aging. Naming the type, whether stress, urge, mixed, overflow or functional, guides the treatment.
Key symptoms
- Leaking with cough, sneeze, laugh or lifting (stress)
- Leaking with a sudden strong urge (urge)
- Constant dribbling with a weak stream and incomplete emptying (overflow)
- Leaking because of trouble reaching the toilet in time (functional)
What you find on exam
- Abdominal exam for a distended bladder
- Pelvic exam: prolapse, atrophy and a cough stress test
- Rectal exam: tone, stool impaction and prostate
- Neuro exam, mobility and cognition
Tests
- Urinalysis for infection, blood and glucose
- Post-void residual with a bladder scan
- Bladder diary for 3 days
- Medication review: diuretics, anticholinergics and sedatives; urodynamics before surgery
Treatment basics
- Treat reversible causes: infection, constipation, drugs, high glucose and poor mobility
- Stress: pelvic floor muscle training, pessary or a midurethral sling
- Urge: bladder training plus mirabegron or an antimuscarinic
- Overflow: relieve the blockage and use clean intermittent catheterization
- Functional: prompted toileting and skin care
Red flags
- Blood in the urine
- Large post-void residual or retention
- New incontinence with back pain, leg weakness or saddle numbness (cauda equina)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.