Urinary Incontinence

Types of incontinence

Type	Mechanism	Symptoms	Signs	Treatment
stress	abdominal pressure against a weakened urethral sphincter	momentary leak with a small amount lost with sneezing laughing, etc.	nonpalpable bladder, atrophy and incontinence	kegel excercises, pessary, consult urology/gyne
urge	decreased detrusor contraction increasing of sensory pathways deconditioned voiding reflex	urge to void moderate volume nocturia dysuria	nonpalpable bladder signs of CNS disease fecal impaction	decreased night fluids pads retrain bladder with regular toileting
overflow	poor detruser control outlet obstruction (ie BPH) decreased bladder sensation	continuous dribble decreased stream force urinary obstruction	large tender bladder large prostate decreased perineal sensation decreased anal reflex motor disease	catheter consult urology for bladder dynamics
functional	decreased mobility or environmental	incontinent on way to bathroom or in early morning	non palpable bladder	improve mobility change environment
true	fistula ectopic ureteric orifice	constant dribble small amount of urine	urine from vagina or ectomic orifice	surgery
post void dribble	psychogenic prostatitis obstruction

HPI:

Timing

When: day/night
Duration
Flow
Activity
Intermittent/constant
New or ongoing

Urinary Sx

Dysuria
abnormal urine
hesitancy
urgency
quality of stream
volume
aware of urine loss
relieving/aggrevating factors
post void dribble

Systemic

fever
polydipsea
decreased perineal sensation
stool incontinence

PMHx

Medical

Cancer
Diabetes
Stones
CVA/Parkinson's/Dementia
hypercalcemia (exhibits polyurea and polydipsea)
prostatic hypertrophy

Surgical

Vaginal/pelvic
prostate

Gyne

Gestation/Parity

Medications

Sedatives
Tranquilizers
anticholinergics
Sympathetic blockers
diuretics

Family history

any similar problems in family?

Social history

Function at home
restricted mobility
employment
EtOH
Caffiene
smoking

Review of systems

endocrine
- menopause/atrophic vaginitis
neuro
- sensory or motor changes?
GI
- constipation/diarrhea

Etiology

DRIP
- Dementia/Delerium
- Restricted mobility
- Infection
- Pharmacy

Treatable causes of urinary incontinence

D elirium
I nfection--urinary (symptomatic)
A trophic urethritis and vaginitis
P harmaceuticals
P sychologic disorders, especially depression
E xcessive urine output (eg, from heart failure or hyperglycemia)
R estricted mobility
S tool impaction

Other OSCE modules

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