Summary
Definition
History and exam
Key diagnostic 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
- uterine prolapse or posterior support weakness
- abnormal bulbocavernosus and wink reflexes
- weakened sphincter tone
- chronic heart failure
- diabetes mellitus
- excess fluid intake
- postvoid dribbling
- hematuria
- history of recurrent urinary tract infections
- enlarged uterus
- fecal impaction
- loss of perineal sensation
Risk factors
- increasing age
- white ethnicity
- pregnancy
- obesity
- postmenopausal 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
- fecal incontinence
- high-impact physical activity
- pelvic organ prolapse
- genitourinary and pelvic surgery
- radiation exposure
- stroke and other central nervous system/spinal disorders
- Parkinson 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
- postvoid residual measurement
- cough stress test
Investigations to consider
- pad test
- urodynamic testing
- Q-tip test
- transperineal ultrasound
- cystourethroscopy
Treatment algorithm
stress incontinence
urgency incontinence
mixed incontinence
Contributors
Authors
G. Willy Davila, MD
Medical Director
Women and Children’s Services
Urogynecology and Pelvic Reconstructive Surgery
Holy Cross Medical Group
Fort Lauderdale
Florida
FL
Disclosures
GWD is a consultant/advisory board member for Boston Scientific and Laborie/Cogentix, and a speaker for Laborie/Cogentix, Astellas, Alma, and Ferring. GWD has received research grants from POP Medical, Pfizer, Cook Biomedical, Alma, and Coloplast.
Laura Martin, DO
Assistant Professor
University of Miami
Urology Department
Female Pelvic Medicine and Reconstructive Surgery
Miami
MIA
Disclosures
LM declares that she has no competing interests.
Acknowledgements
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, the previous contributors to this topic.
Disclosures
ANA, ALS, MJM, and PAC declare that they have no competing interests.
Peer reviewers
James Kuan, MD, FRSC, FACS
Department of Urology
University of Washington
School of Medicine
Seattle
WA
Disclosures
JK declares that he has no competing interests.
Mohamed Y. Hammadeh, MSc (Urol), FEBU, FRCS (Eng. Urol), Diploma ME (UCL)
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.
Differentials
- Urogenital fistula (urethrovaginal, ureterovaginal, and vesicovaginal fistula)
- Ectopic ureter
- Urinary tract infection
More DifferentialsGuidelines
- Urinary incontinence
- Surgical treatment of female stress urinary incontinence
More GuidelinesPatient leaflets
Stress incontinence
Stress incontinence: how to do pelvic floor exercises
More Patient leaflets
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