Urinary incontinence

Differential diagnosis

  • Pelvic mass – Ovarian Ca, fibroids – weight loss, menstrual history
  • UTI – dysuria, fever
  • Constipation – bowels
  • Prolapse – sensation of something coming down
  • Stress incontinence – coughing, sneezing
  • Urge incontinence – sudden urge

 

Data gathering

  • Red flags – Haematuria, weight loss
  • Others – coughing/sneezing, frequency, urgency, dysuria, feeling of something coming down, fluid, caffeine, alcohol, obstetric history
  • Examine – Abdominal exam, BMI, prostate, speculum (prolapse)

 

Clinical management

  • Investigations
    • Bloods – U+Es
    • Urine – dipstick, MSU
    • USS – pelvis, KUB
  • Explanation
    • Stress incontinence – weak pelvic floor muscles lead to pressure from bladder overcoming the outlet
    • Urge incontinence – bladder muscles overly strong contractions leading to an urgent desire to pass urine
  • Treatment
    • Lifestyle – weight loss, reduce caffeine and alcohol, incontinence pads
    • Bladder diary
    • Pelvic floor training 3 months (stress)
      • home exercises – same movement as stopping passing urine mid stream, hold this for 5-10 seconds followed by a few quick holds – three times/day
      • physiotherapy – pelvic cones
    • Bladder training 6 weeks (urge)
    • Medications – oxybutynin (urge)
  • Safety-net / Follow-up
    • Refer
      • failure of conservative management
      • symptomatic prolapse