Trial of conservative management of UI for 6-8 weeks.Positive bladder stress test : urinary leakage during activities that increase intraabdominal pressure (e.g., coughing, Valsalva maneuver).Increase in intraabdominal pressure (e.g., from laughing, sneezing, coughing, exercising) → ↑ pressure within the bladder → bladder pressure > urethral sphincter resistance to urinary flow.Intrinsic sphincter deficiency, caused by:.Childbirth (i.e., damage of the pelvic floor muscle levator ani and/or the S2 – S4 nerve roots ).Poor pelvic support caused by pelvic postmenopausal estrogen loss.Urethral hypermobility in women ( bladder outlet incompetence ) secondary to:.Excessive urinary output (in conditions like hyperglycemia, hypercalcemia, CHF)ĭIAPPERS: Delirium/confusion, Infection, Atrophic urethritis/ vaginitis, Pharmaceutical, Psychiatric causes (especially depression), Excessive urinary output ( hyperglycemia, hypercalcemia, CHF), Restricted mobility, Stool impaction.Psychiatric causes (especially depression, delirium/confused state).
Initial management involves conservative measures (e.g., management of comorbidities, pelvic floor exercises, bladder training) and provision of continence products further treatment is based on the underlying mechanism and may involve pharmacotherapy or surgery. Advanced diagnostic studies may be required for patients with red flags in urinary incontinence or incontinence refractory to treatment. The diagnosis can often be made based on a detailed medical history, a voiding diary, physical examination, and basic testing including urinalysis and measurement of postvoid residual volume ( PVR). UI is more common in older individuals, and approximately twice as common in women than in men. Stress incontinence, urge incontinence, and mixed incontinence are the most common types. Urinary incontinence (UI) is a common condition characterized by involuntary leakage of urine.