![]() Urinary incontinence is a salient issue in any primary care physician practice. The grade of uterine, vaginal prolapse should be assessed along with obvious stress urinary incontinence with coughing. The patient should be examined with both a full and empty bladder in standing and supine positions. A large panniculus, prior surgical incisions, and suprapubic muscle tone should be noted. The focus on the physical exam on patients with mixed incontinence should focus on abdominal and pelvic areas. Bladder diaries may be used by both patient and physician for objective means of quantifying incontinence. Lack of estrogen during perimenopause or postmenopause should also be discussed. Comorbidities and confounding factors should also be explored. Medications that affect urinary incontinence should be reviewed, particularly cholinergic drugs and diuretics. Many validating questionnaires can assess symptomatic effects on daily living. These can include duration, precipitating events, voiding frequency, and fluid intake. Details about the nature of incontinence are invaluable. Signs may include hesitancy, slow stream, straining to void, incomplete emptying, or wetting pads or clothes. The clinician should ask for this information directly since the patient may be too embarrassed to talk about symptoms of increased frequency, urgency, or dysuria. Ī thorough history needs to be obtained to help diagnose urinary incontinence. This type may take on the pathophysiology of both. Mixed urinary incontinence is a combination of stress and urge incontinence. The pathophysiology is uninhibited bladder contractions caused by irritation or loss of neurologic control of bladder contractions. Bladder contractions may be stimulated by a change in body position (from supine to upright) or with sensory stimulation (running water, hand washing, cold weather). Urge incontinence is the involuntary loss of urine preceded by a sudden and severe desire to pass urine. The pathophysiology is due to pelvic floor weakness/prolapse and/or loss of the normal urethra vesical angle. ![]() Stress incontinence is the involuntary loss of urine with increased intraabdominal pressure or physical exertion (coughing, sneezing, jumping, lifting, exercise). Classification is endorsed by the International Urogynecological Association (IUGA)/International Incontinence Society (ICS). There are also a variety of subtypes including genitourinary (fistula, infectious, congenital) and non-genitourinary (functional, environmental, pharmacological, metabolic). ![]()
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