Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • involuntary urine leakage on effort, exertion, sneezing, or coughing
  • involuntary urine leakage accompanied by or immediately preceded by urgency
  • frequency of urination
  • suggestive bladder diary
  • vaginal bulge/pressure
  • urogenital atrophy
  • history of cognitive impairment
  • back injury
  • dysuria
  • abnormal mental state
  • pooling of urine in vaginal tract
  • urethral discharge or tenderness

Other diagnostic factors

  • nocturia
  • abnormal bulbocavernosus and wink reflexes
  • weakened sphincter tone
  • chronic heart failure
  • diabetes mellitus
  • excess fluid intake
  • post-void dribbling
  • haematuria
  • history of recurrent UTIs
  • enlarged uterus
  • faecal impaction
  • loss of perineal sensation

Risk factors

  • increasing age
  • white ethnicity
  • pregnancy
  • obesity
  • post-menopausal status
  • functional impairment
  • lower urinary tract symptoms
  • long-term residence in a care facility
  • dementia
  • family history of incontinence
  • childhood enuresis
  • chronic cough
  • diabetes mellitus
  • depression
  • chronic heart failure
  • smoking
  • constipation
  • faecal incontinence
  • high-impact physical activity
  • pelvic organ prolapse
  • genitourinary and pelvic surgery
  • radiation exposure
  • stroke
  • Parkinson's disease
  • multiple sclerosis
  • diuretic use
  • caffeine consumption
  • alcohol consumption
  • antihistamine use
  • sedative use
  • hypnotic use
  • narcotic analgesic use
  • anticholinergic use
  • antidepressant use
  • antipsychotic use
  • alpha-adrenergic agonist use
  • calcium-channel blocker use

Diagnostic investigations

1st investigations to order

  • empty supine stress test
  • urinalysis
  • post-void residual measurement (PVR)
  • cough stress test
Full details

Investigations to consider

  • pad test
  • urodynamic testing
  • Q-tip test
  • cystourethroscopy
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Chairman

Department of Gynecology

Head

Division of Urogynecology and Reconstructive Pelvic Surgery

Cleveland Clinic Florida

Weston

FL

Disclosures

GWD has received research grants from Pfizer and Alma Lase paid to the Cleveland Clinic, and has received speaker honorarium from Astellas and Cogentix.

Clinical Fellow

Division of Urogynecology and Reconstructive Pelvic Surgery

Cleveland Clinic Florida

Weston

FL

Disclosures

LM declares that she has no competing interests.

Dr G. Willy Davila and Dr Laura Martin would like to gratefully acknowledge Dr Alexandriah N. Alas, Dr Aimee Lynn Smith, Dr Marjorie Jean-Michel, and Dr Peter A. Castillo, previous contributors to this monograph. ANA, ALS, MJM, and PAC declare that they have no competing interests.

Peer reviewers VIEW ALL

Department of Urology

University of Washington

School of Medicine

Seattle

WA

Disclosures

JK declares that he has no competing interests.

Consultant Urological Surgeon

Foundation Training Programme Director

South London Healthcare NHS Trust

Queen Elizabeth Hospital

London

UK

Disclosures

MYH declares that he has no competing interests.

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