The Rational Clinical Examination
David L. Simel, Drummond Rennie
Urinary Incontinence, Women
Jayna M. Holroyd-Leduc, Cara Tannenbaum, Kevin E. Thorpe, Sharon E. Straus
A bladder diary, which measures the frequency and volume of urine output and the circumstances...
Topics Discussed:
diagnosis, differential, diagnostic process, medical history, pelvic floor, physical examination, q-tip urethrovesical angle test, urinary incontinence, women's health
Excerpt:
"Urinary incontinence, defined as involuntary leakage of urine,
affects up to 55% of women.1,2 It can
be divided into several different types, including stress, urge,
mixed, overflow, and functional incontinence. The symptom of stress
incontinence is involuntary leakage on effort or exertion, or on
sneezing or coughing,1 and it is the result of
weak pelvic floor muscles, poor intrinsic sphincter function, increased
urethral mobility, or all of the above (Figure 56-1). The symptom
of urge incontinence is involuntary leakage accompanied or immediately
proceeded by urgency (a sudden strong need to void),1 and
it results from detrusor overactivity. Mixed incontinence is the
combination of stress and urge incontinence. Women with mixed incontinence
can have both stress and urge symptoms with the same incontinence
episode, while others can experience discrete episodes of stress
or urge incontinence. Overflow incontinence is associated with overdistention
of the bladder caused by obstruction (eg, pelvic organ prolapse)
or a neurological condition (eg, spinal cord injury). Functional
incontinence is incontinence resulting from cognitive, functional,
or mobility difficulties in a person who may or may not have lower
urinary tract deficits.The prevalence of urinary incontinence varies depending on the
sex and age group examined. The definition of urinary incontinence
used (daily vs weekly vs monthly vs any episodes of involuntary
leakage) also impacts reported prevalence rates. The overall prevalence
of urinary incontinence among older women ranges from 17% to
55%, with daily incontinence ranging from 3% to 17%.2 Among
middle aged and younger women, the overall prevalence ranges
from 12% to 42%.2..."
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