Urinary Incontinence For Health Professionals: Differential Diagnosis

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Differential Diagnosis

Establish the type of urinary incontinence, after having eliminated reversible causes.

Stress incontinence

Definition: involuntary loss of urine that occurs during physical activity, coughing, sneezing, rising from a sitting position

  • without pelvic floor muscle weakness
    • attributable to a deficiency of the internal sphincter or to an anatomic deviation of the bladder neck
      • particularly in women who have had a difficult childbirth or who suffer from hereditary collagen problems
    • attributable to urethral instability
  • with pelvic floor muscle weakness (deficiency of the external sphincter)
    • attributable to sarcopenia, obesity, or recurrent straining

Urgency incontinence

Definition: a strong, sudden need to urinate accompanied by involuntary urine loss

  • attributable to factors such as age or idiopathic
  • attributable to damage to central inhibition pathways:
    • frontal stroke, Parkinson's disease, tumour, normal pressure hydrocephalus
  • attributable to localized bladder irritation:
    • stones, polyps, cancer, cystitis
  • attributable to pelvic floor muscle weakness associated with excess consumption of caffeinated drinks (often along with difficulty walking)

Overflow incontinence due to chronic urniary retention

Definition: involuntary loss of urine associated with bladder retention in the absence of detrusor contraction.

  • Bladder obstruction:
    • in women: large cystocele or prolapse, stenosis following surgery or radiotherapy.
  • Detrusor dysfunction:
    • injury to the spinal cord, metastasis of the spinal cord, spinal stenosis
    • anticholinergic or narcotic medication

Mixed incontinence

Definition: usually a combination of both stress and urgency urinary incontinence 

Next: Treatment Options

 

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