Urinary Incontinence

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of urinary incontinence

Type of incontinence: ‍stressurgeoverflowfunctionalmixed

Frequency of episodes: ‍ times ‍per dayoverall

Volume: ‍smalllarge

Triggered by ‍coughingsneezinglifting heavy objectslaughing

Alleviating factors: ‍none, ‍effectiveineffective

Impact on daily life or mental health: ‍minimal



Associated symptoms: *Try using right-click for negatives*

‍urgency

‍frequency

‍nocturia

‍urinary retention

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍pelvic pain

‍constipation



Contributing factors:

‍obesity

‍smoking

‍high impact exercise

‍caffeine intake

‍fluid intake

‍alcohol consumption

no history of: ‍prostate disease, ‍neurological disorders, ‍diabetes, ‍childbirth, ‍pelvic surgery

no use of: ‍diuretics, ‍alpha blockers, ‍anticholinergics, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Lumbar spine: ‍tenderness on ‍, range of motion ‍fulllimited

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady





ASSESSMENT:

‍Urinary incontinence ‍likelysuspectedpossible

DDx: stress incontinence, urge incontinence, overflow incontinence, functional incontinence, mixed incontinence, neurogenic bladder, urinary tract infection, benign prostatic hyperplasia, medication side effect, constipation, diabetes mellitus, neurological disorders, pelvic floor weakness, prostate surgery, vaginal delivery, menopause, cognitive impairment, mobility issues, excessive fluid intake, alcohol consumption, caffeine consumption, bladder stones, bladder cancer, chronic cough, obesity, pelvic organ prolapse, spinal cord injury, cauda equina syndrome





PLAN:

Investigations:

- Urinalysis

- Urine culture

- Blood work: ‍CBC, ‍creatinine, ‍glucose

- Bladder scan

- Pelvic ultrasound

- Urodynamic testing

- Cystoscopy

- Post-void residual urine volume

Treatments:

- ‍Anticholinergics

- ‍Mirabegron

- ‍Topical estrogen

- Pelvic floor muscle exercises

- Bladder training

- Limit alcohol intake

- Limit caffeine intake

- Weight loss counseling

- Absorbent pads

- Catheterization

Further care:

- 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