Summary
Definition
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
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
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
Diagnostic investigations
1st investigations to order
- cough stress test
- urinalysis
- post-void residual measurement
- empty supine stress test
Investigations to consider
- urodynamic testing
- pad test
- 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
Female Pelvic Medicine and Reconstructive Surgery
Department of Urology
University of Miami Miller School of Medicine
University of Miami Health System
Miami
FL
Disclosures
LM is a consultant for Coloplast educational pelvic floor cadaver labs.
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
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
Disclosures
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
Nashville
TN
Disclosures
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
London
UK
Disclosures
MYH declares that he has no competing interests.
Differentials
- Urogenital fistula (urethrovaginal, ureterovaginal, uterovaginal, and vesicovaginal fistula)
- Ectopic ureter
- Urinary tract infection
More DifferentialsGuidelines
- Non-neurogenic female LUTS
- Surgical treatment of female stress urinary incontinence
More GuidelinesPatient leaflets
Stress incontinence
Stress incontinence: how to do pelvic floor exercises
More Patient leaflets
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer