Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- age over 50 years
- BMI over 25
- increased parity
- involuntary urine leakage on effort, exertion, sneezing, or coughing
- involuntary urine leakage accompanied by or immediately preceded by urgency
- frequency of urination
- nocturia
- use of drugs that can cause urinary incontinence
Otros factores de diagnóstico
- suggestive bladder diary
- vaginal bulge/pressure
- urogenital atrophy
- uterine prolapse or posterior support weakness
- long-term residence in a care facility
- chronic heart failure
- diabetes mellitus
- excess fluid intake
- cognitive impairment on mental state exam
- history of neurological disease
- history of back injury
- history of recurrent urinary tract infections
- dysuria
- haematuria
- post-void dribbling
- pooling of urine in vaginal tract
- urethral discharge or tenderness
- enlarged uterus
- loss of perineal sensation
- abnormal bulbocavernosus and wink reflexes
- weakened sphincter tone
- faecal impaction
Factores de riesgo
- increasing age
- pregnancy
- obesity
- pelvic organ prolapse
- post-menopausal status
- diuretic use
- caffeine consumption
- constipation
- faecal incontinence
- high-impact physical activity
- obstructive sleep apnoea
- long-term residence in a care facility
- dementia
- stroke and other central nervous system/spinal disorders
- Parkinson's disease
- multiple sclerosis
- white women
- functional impairment
- family history of incontinence
- childhood enuresis
- chronic cough
- diabetes mellitus
- depression
- chronic heart failure
- smoking
- genitourinary and pelvic surgery
- radiation exposure
- alcohol consumption
- antihistamine use
- sedative use
- hypnotic use
- opioid analgesic use
- anticholinergic use
- antidepressant use
- antipsychotic use
- alpha-blocker use
- calcium-channel blocker use
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- cough stress test
- urinalysis
- post-void residual measurement
- empty supine stress test
Pruebas diagnósticas que deben considerarse
- urodynamic testing
- pad test
- Q-tip test
- transperineal ultrasound
- cystourethroscopy
Algoritmo de tratamiento
stress incontinence
urgency incontinence
mixed incontinence
Colaboradores
Autores
G. Willy Davila, MD
Medical Director
Women and Children’s Services
Urogynecology and Pelvic Reconstructive Surgery
Holy Cross Medical Group
Fort Lauderdale
Florida
FL
Divulgaciones
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
Female Pelvic Medicine and Reconstructive Surgery
Department of Urology
University of Miami Miller School of Medicine
University of Miami Health System
Miami
FL
Divulgaciones
LM is a consultant for Coloplast educational pelvic floor cadaver labs.
Agradecimientos
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.
Divulgaciones
ANA, ALS, MJM, and PAC declare that they have no competing interests.
Revisores por pares
Roger R. Dmochowski, MD, MMHC
Professor of Urology and Surgery
Department of Urology
Vanderbilt University Medical Center
Nashville
TN
Divulgaciones
RRD declares that he has no competing interests.
Heidi Brown, MD, MAS
Assistant Professor
Female Pelvic Medicine and Reconstructive Surgery
Departments of Obstetrics and Gynecology & Urology
University of Wisconsin School of Medicine and Public Health
Madison
WI
Divulgaciones
HB receives royalties for authorship from Wolters-Kluwer, Inc. and Springer, Inc. HB provides expert consultations for Grand Rounds, Inc. HB has research funding from the National Institutes of Health, serves on the Editorial Board of Female Pelvic Medicine and Reconstructive Surgery, and is on the Board of Directors for the American Urogynecologic Society (AUGS) and the Pelvic Floor Disorders Research Foundation.
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American College of Obstetricians and Gynecologists. Practice bulletin no. 155: urinary incontinence in women. Nov 2015 [internet publication].Full text
European Association of Urology. Non-neurogenic female LUTS. 2023 [internet publication].Full text
National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. Jun 2019 [internet publication].Full text
Kobashi KC, Vasavada S, Bloschichak A, et al. Updates to surgical treatment of female stress urinary incontinence (SUI): AUA/SUFU guideline (2023). J Urol. 2023 Jun;209(6):1091-98.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Urogenital fistula (urethrovaginal, ureterovaginal, uterovaginal, and vesicovaginal fistula)
- Ectopic ureter
- Urinary tract infection
More DifferentialsGuidelines
- The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder (2024)
- Urinary incontinence and pelvic organ prolapse in women: management
More GuidelinesPatient information
Stress incontinence in women
Stress incontinence: how to do pelvic floor exercises
More Patient information
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