Urinary Incontinence

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Types of incontinence[edit]

Type Mechanism Symptoms Signs Treatment
stress abdominal pressure against a weakened urethral sphincter momentary leak with a small amount lost with sneezing laughing, etc. nonpalpable bladder, atrophy and incontinence kegel excercises, pessary, consult urology/gyne
urge decreased detrusor contraction

increasing of sensory pathways deconditioned voiding reflex

urge to void

moderate volume nocturia dysuria

nonpalpable bladder

signs of CNS disease fecal impaction

decreased night fluids

pads retrain bladder with regular toileting

overflow poor detruser control

outlet obstruction (ie BPH) decreased bladder sensation

continuous dribble

decreased stream force urinary obstruction

large tender bladder

large prostate decreased perineal sensation decreased anal reflex motor disease

catheter

consult urology for bladder dynamics

functional decreased mobility or environmental incontinent on way to bathroom or in early morning non palpable bladder improve mobility

change environment

true fistula

ectopic ureteric orifice

constant dribble

small amount of urine

urine from vagina or ectomic orifice surgery
post void dribble psychogenic

prostatitis obstruction


HPI:[edit]

Timing[edit]

  • When: day/night
  • Duration
  • Flow
  • Activity
  • Intermittent/constant
  • New or ongoing

Urinary Sx[edit]

  • Dysuria
  • abnormal urine
  • hesitancy
  • urgency
  • quality of stream
  • volume
  • aware of urine loss
  • relieving/aggrevating factors
  • post void dribble

Systemic[edit]

  • fever
  • polydipsea
  • decreased perineal sensation
  • stool incontinence

PMHx[edit]

Medical[edit]

  • Cancer
  • Diabetes
  • Stones
  • CVA/Parkinson's/Dementia
  • hypercalcemia (exhibits polyurea and polydipsea)
  • prostatic hypertrophy

Surgical[edit]

  • Vaginal/pelvic
  • prostate

Gyne[edit]

  • Gestation/Parity


Medications[edit]

  • Sedatives
  • Tranquilizers
  • anticholinergics
  • Sympathetic blockers
  • diuretics

Family history[edit]

  • any similar problems in family?

Social history[edit]

  • Function at home
  • restricted mobility
  • employment
  • EtOH
  • Caffiene
  • smoking


Review of systems[edit]

  • endocrine
    • menopause/atrophic vaginitis
  • neuro
    • sensory or motor changes?
  • GI
    • constipation/diarrhea

Etiology[edit]

  • DRIP
    • Dementia/Delerium
    • Restricted mobility
    • Infection
    • Pharmacy

Treatable causes of urinary incontinence[edit]

  • D elirium
  • I nfection--urinary (symptomatic)
  • A trophic urethritis and vaginitis
  • P harmaceuticals
  • P sychologic disorders, especially depression
  • E xcessive urine output (eg, from heart failure or hyperglycemia)
  • R estricted mobility
  • S tool impaction

Other OSCE modules[edit]