Urinary Incontinence

Diagnosis/Definition

Involuntary loss of urine that is bothersome to the patient.

Initial Diagnosis and Management

• Quantify the leakage and ask the patient how much this impacts her daily living (i.e. # of pads/day and whether leak is small or large amount). Leakage that is not bothersome to the patient does not require treatment.
• Urinalysis and culture.
• Acute allergic and asthma symptoms causing sneezing/coughing should be maximally controlled.
• Gynecologic history: post or premenopausal/prior hysterectomy/salpingo-oophorectomy/estrogen replacement/dyspareunia.
• Bladder functions/frequency of voiding/normal sensation of filling and complete emptying/nocturia. Have the patient keep a three-day voiding diary including fluid intake (quantify), micturation, and notation of leaking episodes with events surrounding loss (urge, no sensation, etc.).
• A program of pelvic floor exercises.

Ongoing Management and Objectives

Improvement in involuntary loss of urine.

Indications for Specialty Care Referral

Patient request.

If incontinence impacts daily living enough to warrant medical or surgical treatment.

Criteria for Return to Primary Care

After maximal medical or surgical benefit is obtained.