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Urinary Incontinence

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Sex- and Gender-Based Women's Health

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Abstract

Urinary incontinence is a prevalent condition, especially in adult women. The most common types of urinary incontinence are stress, urge, overflow, and mixed, and each has a physical, social, and economic impact on the lives of those with the condition. Both the pelvic anatomy and the pathophysiology of urinary incontinence inform the approach to management. The history is the most important diagnostic tool, plus a urinalysis to rule out infection. Pelvic floor exercises are the mainstay of treatment for stress or mixed incontinence; urge incontinence may benefit from bladder training and medications. A primary care clinician should know when to refer to specialty care, such as persistent symptoms, concern for neurologic etiology, and consideration of surgery.

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Author information

Authors and Affiliations

  1. University of Kentucky, Department of Internal Medicine, Lexington, KY, USA

    Katherine E. Twist

  2. Robert Larner MD, College of Medicine at The University of Vermont, Department of General Internal Medicine, Burlington, VT, USA

    Halle G. Sobel

Authors
  1. Katherine E. Twist
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  2. Halle G. Sobel
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Corresponding author

Correspondence to Katherine E. Twist .

Editor information

Editors and Affiliations

  1. University of Pittsburgh School of Medicine, Division of General Internal Medicine, Department of Medicine, Pittsburgh, PA, USA

    Sarah A. Tilstra

  2. Harvard Medical School, Massachusetts General Hospital, Department of Medicine, Boston, MA, USA

    Deborah Kwolek

  3. Medical College of Wisconsin, Milwaukee, WI, USA

    Julie L. Mitchell

  4. Northwestern University Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Department of Medicine, Chicago, IL, USA

    Brigid M. Dolan

  5. Hackensack Meridian School of Medicine at Seton Hall, Jersey Shore University Medical Center, Department of Medicine, Neptune, NJ, USA

    Michael P. Carson

Review Questions

Review Questions

  1. 1.

    A 50-year-old woman with a BMI of 41.0 presents to your office with a 3-day history of urinary leakage with coughing and sneezing. She has not noted any blood in her urine but does have mild dysuria. She has had three vaginal deliveries in the past without complications. She has been on lisinopril for 1 year for hypertension.

    What is the first best step in evaluating her urinary leakage?

    1. A.

      Discontinue the ACE inhibitor and reevaluate

    2. B.

      Pelvic exam

    3. C.

      Pelvic floor physical therapy referral

    4. D.

      Urinalysis

    The correct answer is D. The initial evaluation of a patient with new urinary incontinence should include a urinalysis to rule out underlying infection.

  2. 2.

    A 60-year-old overweight female with mixed urge and stress incontinence comes in for a follow-up visit on her symptoms. At your suggestion, she has lost 5 lbs and has participated in pelvic floor physical therapy for 6 months with slight improvement in symptoms, but they are still bothersome. Prior urine studies have been normal. She takes amlodipine, atorvastatin, and vitamin D.

    What is the best next step?

    1. A.

      Order tolterodine

    2. B.

      Refer for a pessary fitting

    3. C.

      Refer for urodynamic studies

    4. D.

      Urinary incontinence pads

    The correct answer is A. This patient has already done first-line therapy which included pelvic floor physical therapy, and she has lost weight which was also recommended as part of lifestyle change. It is reasonable to consider pharmacologic therapy as the next step in her treatment plan [35].

  3. 3.

    A 58-year-old menopausal woman comes in for an annual exam. You inquire about urinary incontinence and find that she wears a liner daily for mild urine leakage. She leaks urine daily without trigger as well as when she coughs, sneezes, or laughs. She has a history of osteoporosis and allergic rhinitis for which she takes occasional antihistamines. On exam, you find mildly thin and dry vaginal mucosa and no signs of pelvic organ prolapse. A urinalysis is normal. What is the best next step in managing her symptoms?

    1. A.

      Order oral estrogen

    2. B.

      Order oxybutynin

    3. C.

      Refer to pelvic physical therapy

    4. D.

      Refer to urology or urogynecology

    Correct answer: C. The clinician should recommend pelvic floor physical as this is an effective behavioral therapy for urinary incontinence [2]. Topical estrogen could also be tried in this patient, but oral estrogen is not recommended for vaginal atrophy.

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Twist, K.E., Sobel, H.G. (2020). Urinary Incontinence. In: Tilstra, S.A., Kwolek, D., Mitchell, J.L., Dolan, B.M., Carson, M.P. (eds) Sex- and Gender-Based Women's Health. Springer, Cham. https://doi.org/10.1007/978-3-030-50695-7_23

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  • DOI: https://doi.org/10.1007/978-3-030-50695-7_23

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-50694-0

  • Online ISBN: 978-3-030-50695-7

  • eBook Packages: MedicineMedicine (R0)

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