Urinary Incontinence

HISTORY:

Urinary incontinence for ‍ ‍hoursdays

Type: ‍stressurgeoverflowfunctionalmixed

Frequency: ‍ times ‍per dayoverall

Volume: ‍smalllarge

Worsening factors: ‍coughingsneezinglifting heavy objectslaughing

Treatments tried: ‍none, ‍effectiveineffective

Impact on daily life or mental health: ‍minimal

‍urgency

‍frequency

‍nocturia

‍urinary retention

‍abdominal pain

‍pelvic pain

‍constipation



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness

Genital: ‍normal, testicles ‍normal, penis ‍normal

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍

Lumbar spine: ‍no tenderness on ‍, range of motion ‍fulllimited

Neurologic: cranial nerves ‍normal, strength ‍5/5 throughout, sensation ‍normal, reflexes ‍2+ throughout, cerebellar function ‍normal, gait ‍stable



ASSESSMENT:

‍Urinary incontinence ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Urinalysis

- Urine culture

- Blood work: ‍CBC, ‍creatinine, ‍glucose

- Bladder scan

- Pelvic ultrasound

- Urodynamic testing

- Cystoscopy

- Post-void residual urine volume

- ‍Anticholinergics

- ‍Mirabegron

- ‍Topical estrogen

- Pelvic floor muscle exercises

- Bladder training

- Limit alcohol intake

- Limit caffeine intake

- Weight loss counseling

- Absorbent pads

- Catheterization

- Referral to urologist

- Referral to physiotherapist for pelvic floor therapy

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen or if new symptoms develop such as urinary retention, recurrent urinary tract infections, or hematuria