Make the Diagnosis: Urinary Incontinence, Women
Urinary incontinence is the involuntary leakage of urine. The reported prevalence of urinary incontinence among older women ranges from 17% to 55%, with daily incontinence ranging from 3% to 17%.1 The prevalence rates depend, in part, on the definition of urinary incontinence used: daily vs weekly vs monthly vs any episodes of involuntary leakage. Among middle-aged and younger women, the reported prevalence ranges from 12% to 42%.1 The type of urinary incontinence varies with age: women younger than 65 years with incontinence tend to have stress incontinence (50%-66%), while those older than 65 years have a lower frequency of stress incontinence (25%-33%).
Population for Whom Urinary Incontinence Should Be Considered
A woman has incontinence when she says she has urinary leakage, and the symptoms should not be ignored. The presence of incontinence symptoms may also be revealed during the review of symptoms and should be asked among women who have had children or who are older. Women with Parkinsonism, arthritis, diabetes, stroke, dementia, spinal cord injury, or other illness that might limit mobility should be specifically asked about urine leakage.
Assessing the Likelihood of Different Types of Urinary Incontinence
Stress, urge, mixed (a combination of stress and urge), overflow, and functional incontinence are the different types of urinary incontinence. The initial evaluation typically attempts to differentiate stress from urge incontinence. Patients can have overactive bladder symptoms but do not have incontinence if they can reach the bathroom in time to avoid leakage.
Urge incontinence is assessed by the patient's symptoms, while stress incontinence can be assessed through a combination of symptoms and examination maneuvers. The overall clinical assessment, after taking the patient's history and conducting a clinical examination, provides useful information.
The complaint of urinary leakage defines incontinence. The reference standard for the type of urinary incontinence is either urodynamic testing, expert opinion, or a combination of both. This approach reflects the clinical realities of the disorder, especially since urodynamic tests are interpreted by experts who often have the clinical information. See Table 56-1.
TABLE 56–1Likelihood Ratios That a Patient Has Urinary Incontinence ||Download (.pdf) TABLE 56–1 Likelihood Ratios That a Patient Has Urinary Incontinence
| ||Type of Incontinence ||LR+ (95% CI) ||LR- (95% CI) |
| ||Symptoms |
|“Do you experience such a strong and sudden urge to void that you leak before reaching the toilet?” ||Urge ||4.2 (2.3-7.6) ||0.48 (0.36-0.62) |
|Coughing, sneezing, lifting, walking, or running initiates urinary leakage ||Stress ||2.2 (1.6-3.2) ||0.39 (0.25-0.61) |
| ||Clinical Examination and Evaluation |
|Stress Test ||Stress ||3.1 (1.7-5.5) ||0.36 (0.21-0.60) |
|Overall Clinical Assessment ||Stress ||3.7 (2.6-5.2) ||0.20 (0.08-0.51) |
|Urge ||2.2 (0.55-8.7) ||0.63 (0.34-1.2) |