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Urinary incontinence in women

Last reviewed: 4 Sep 2023
Last updated: 12 Apr 2023



History and exam

Key diagnostic factors

  • 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 medications that can cause urinary incontinence
More key diagnostic factors

Other diagnostic factors

  • 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 neurologic disease
  • history of back injury
  • history of recurrent urinary tract infections
  • dysuria
  • hematuria
  • 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
  • fecal impaction
Other diagnostic factors

Risk factors

  • increasing age
  • pregnancy
  • obesity
  • pelvic organ prolapse
  • postmenopausal status
  • diuretic use
  • caffeine consumption
  • constipation
  • fecal incontinence
  • high-impact physical activity
  • obstructive sleep apnea
  • long-term residence in a care facility
  • dementia
  • stroke and other central nervous system/spinal disorders
  • Parkinson 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
  • narcotic analgesic use
  • anticholinergic use
  • antidepressant use
  • antipsychotic use
  • alpha-blocker use
  • calcium-channel blocker use
More risk factors

Diagnostic investigations

1st investigations to order

  • cough stress test
  • urinalysis
  • post-void residual measurement
  • empty supine stress test
More 1st investigations to order

Investigations to consider

  • urodynamic testing
  • pad test
  • Q-tip test
  • transperineal ultrasound
  • cystourethroscopy
More investigations to consider

Treatment algorithm


stress incontinence

urgency incontinence

mixed incontinence



G. Willy Davila, MD

Medical Director

Women and Children’s Services

Urogynecology and Pelvic Reconstructive Surgery

Holy Cross Medical Group

Fort Lauderdale




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




LM is a consultant for Coloplast educational pelvic floor cadaver labs.


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.


ANA, ALS, MJM, and PAC declare that they have no competing interests.

Peer reviewers

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




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.

​Roger R. Dmochowski, MD, MMHC

Professor of Urology and Surgery

Department of Urology

Vanderbilt University Medical Center




RRD 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




MYH declares that he has no competing interests.

  • Differentials

    • Urogenital fistula (urethrovaginal, ureterovaginal, uterovaginal, and vesicovaginal fistula)
    • Ectopic ureter
    • Urinary tract infection
    More Differentials
  • Guidelines

    • Non-neurogenic female LUTS
    • Surgical treatment of female stress urinary incontinence
    More Guidelines
  • Patient leaflets

    Stress incontinence

    Stress incontinence: how to do pelvic floor exercises

    More Patient leaflets
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