Urinary Incontinence Handout
Urinary Incontinence Handout
Definition
Risk factors
- Female: male 3:1
- Age >60 years
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Lily Arya, MD, Asst. Prof.
Urogynecology & Reconstructive Pelvic Surgery
University of Pennsylvania
- Race: Caucasian, Egyptian and South Asian (Indian) women
- Pregnancy and Childbirth
- Menopause
- Smoking: increases risk of stress and urge incontinence
- Caffeine: increases urge incontinence
- Obesity
- Pelvic organ prolapse: such as cystocele is often associated with UI (due to
common causative factors such as loss of urethrovesical support from childbirth
or aging) but it does not cause UI in itself. (So correction of cystocele does not
correct UI!)
Screening
Ask the question!
Tell me about the problems with your bladder
Tell me about the problem you are having holding your water
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Lily Arya, MD, Asst. Prof.
Urogynecology & Reconstructive Pelvic Surgery
University of Pennsylvania
• Associated symptoms:
-Frequency: r/o UTI that can cause UI or worsen mild UI
-Voiding difficulty: such as hesitancy, or failure to empty completely. If present, it
complicates the evaluation and management of UI. Anti-cholinergic medications or
surgery may be contraindicated in these women.
• Fecal incontinence: associated with UI in 10-25% cases
Medical History
Genitourinary history
• Estrogen loss (hot flushes, vaginal irritation due to atrophy): increase symptoms such
as urgency and frequency
• Bowel habits: Constipation worsens UI
Surgical History
Prior anti-incontinence surgery, prolapse surgery, perhaps hysterectomy: can increase
scarring at the bladder neck and cause intrinsic sphincter deficiency
Social History
• Living conditions: toilet accessibility for elderly people with limited mobility
• Fluid intake: both excessive and low intake has been shown to adversely affect UI
• Smoking, caffeine intake
General Examination
• Mental status: if impaired can cause overflow
• Mobility: if poor can cause urge incontinence
• Edema: mobilization of fluid at night can cause nocturia and urge UI
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Lily Arya, MD, Asst. Prof.
Urogynecology & Reconstructive Pelvic Surgery
University of Pennsylvania
• Neurologic Exam: Look for lower limb weakness, sensory loss in lower limbs and
abnormal knee and ankle jerks for neurologic causes of UI such as multiple sclerosis,
stroke, neuropathies
• Abdomen: mass, ascites can cause UI by pressure effect
Voiding Dairy
Tests
1. Measure Post void residual volume of urine (PVR): straight cath patient in office
after she voids: This helps to rule out retention which can complicate the diagnosis
and management of UI. It also provides a sterile specimen for U/A and culture.
2. Urinalysis and culture: straight cath or clean catch
3. Urodynamics: evaluation of the function of the bladder and the urethra using
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Lily Arya, MD, Asst. Prof.
Urogynecology & Reconstructive Pelvic Surgery
University of Pennsylvania
Treatment of SUI
• Pelvic muscle rehabilitation: Kegel’s exercise with or without biofeedback
• Imipramine (combined anti-cholinergic and alpha-agonist): 10-75 mg per
day: for intrinsic sphincter deficiency only. Side effects: confusion in elderly,
constipation, hypertension, and dry mouth
• Surgery: - bladder neck suspension for anatomic SUI
- suburethral sling or collagen injection for intrinsic sphincter deficiency
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Lily Arya, MD, Asst. Prof.
Urogynecology & Reconstructive Pelvic Surgery
University of Pennsylvania
20) 20)
Treatment Pelvic muscle rehab, Pelvic muscle rehab, Pelvic muscle rehab,
medications (Anti- surgery, no meds! medications
cholinergics), (imipramine),
behavioral surgery
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