Management
Figure 1. Initial Management of Urinary Incontinence in Women Screening Questions (Table 5)
Incontinence on physical activity
Incontinence with mixed symptoms
Incontinence with
urgency/ frequency
Initial evaluation > History and general assessment (Table 2) > Physical examination (Table 3) > Urinalysis ± urine culture (if infected, treat and reassess) > 24-h bladder/voiding diary documenting:
> Use of protective pads/garments (type and number/day) > Assess post-void residual urine (200 mL high; if > 500 mL, catheter decompression then reassess) > Pad test (optional; 20 min-1h or 24 h)
▶ Frequency of urination ▶ Volumes of urination voided ▶ Episodes of incontinence and circumstances ▶ Fluid intake (amount and type)
hypermobility)
incompetence ± urethral
incontinence (sphincter
Stress
predominant problem first
incontinence Treat
Mixed
Empiric treatments oriented to both urge and stress urinary incontinence > Lifestyle modification: smoking cessation, decrease excessive fluid
> Pelvic floor muscle strengthening with (Kegel) exercises ± biofeedback > Bladder retraining, urge suppression training, scheduled or prompted voiding
> Treat severe atrophic vaginitis with topical estrogen
Stress-specific interventions > Devices: provide urethral support and compression, tampon, urethral plug, pessary
> Medications (Table 6) ▶ α-Adrenergic agonist
Failure
Urge-specific interventions > Medications (Table 6)
▶ Antimuscarinic ▶ Anticholinergic
Failure Reassessment or referral for specialist management (Figure 2. Specialist Management)
intake, restrict bladder irritants (caffeine, carbonated beverages, artificial sweeteners), weight reduction, regular bowel movements, adjust physical activity
incontinence (detrusor
Urge overactivity)
Complicated incontinence: > Recurrent incontinence > Continuous leakage > Treatment failure > Incontinence
> Pelvic organ prolapse beyond hymen
associated with: ▶ Pain ▶ Hematuria ▶ Recurrent infection ▶ Elevated PVR ▶ Pelvic irradiation ▶ Radical pelvic surgery ▶ Suspected fistula
> Neurological disease or spinal cord injury
