Female Urinary Incontinence

Key points

Types of urinary incontinence

Incontinence is defined as the involuntary loss of urine. This could be preempted by various stimuli.

Evaluation of the incontinent patient

Evaluation of a woman with urinary incontinence should start with a thorough patient history. It is important to define and quantify the leakage of urine both to understand the cause and to document that any treatment is improving the symptoms. In the incontinent patient, providers should ask the patient to describe her leakage. It should also be noted the daytime urinary frequency, how often the patient wakes at night to void, and if there is ever any sense of urgency related to urination.

Physical examination of the incontinent patient

The components of a thorough physical examination of a woman with incontinence includes a general evaluation, an abdominal examination, a brief neurologic examination, and a detailed pelvic examination. The general evaluation should include the patient’s general ability to understand the urge to urinate and the ability to get to the toilet in an appropriate amount of time. This can be accomplished by asking the patient the detailed questions in your history and also by asking the patient to get

Diagnostic studies in the incontinent female

In straightforward cases of female urinary incontinence, minimal diagnostic studies are indicated. These studies should aim toward diagnosing the reversible and more complex cases of urinary incontinence and include a urinalysis and postvoid residual (PVR). The urinalysis will reveal if the patient has any leukocytes or nitrites in her urine, and, if so, it should be sent for culture and any infection treated appropriately. It will also show if there is excessive protein in the urine, which

Treatment of female incontinence

Once the correct mechanism of leakage is confirmed, the patient can be offered appropriate treatment. Treatment should proceed in a stepwise pattern from least invasive to most invasive. It should also be noted that treatment of the incontinent patient should only occur or progress when the patient is dissatisfied and desires a better quality of life. If a patient is not bothered by her incontinence, or is not bothered enough to proceed with surgical intervention, then that patient should be

Challenging incontinence patients

There are many types of incontinence, and the diagnosis is not always clear to the health care provider. Although diagnostic testing does exist, it is not a requirement before treatment, and many patients have surgery without ever having formal UDS. Even when a woman is referred for UDS, it may not reproduce her leakage, as the conditions in a urodynamic testing room do not exactly mimic real life. Not all women will have a successful result from any incontinence treatment or surgical procedure

Summary

Incontinence is very common, despite the fact it is not often discussed. Although it may not carry significant mortality, it does contribute to feelings of depression, anxiety, and social withdrawal. It is more common with aging and is very common in the nursing home population, often being the final diagnosis leading the caregiver to consider nursing home placement. It can be easy to diagnose by simply talking to patients about their bladder habits and asking if they have incontinence. When