Urinary Incontinence Evaluation and Treatment
Urinary incontinence is the involuntary leakage of urine.
It is often undetected and undertreated by health care personnel despite its impact on an individual’s quality of life. Primary care clinicians are able to initially identify such patients and refer them to a gynecologist for further evaluation.
Many patients are reluctant to initiate a discussion about their incontinence. It is recommended that all women be screened for urinary incontinence during their yearly checkup, particularly women who have had children, comorbid conditions such as diabetes, neurologic disease and who are over 65 years of age.
- Do you ever leak urine when you don’t want to?
- Do you leak urine when you cough, laugh or exercise?
- Do you leak urine on your way to the bathroom?
- Do you wear pads in your underwear to catch urine?
The following terminology can be used when describing a patient's symptoms
- Urgency: sudden desire to pass urine
- Urge incontinence: involuntary leakage accompanied by urgency
- Stress incontinence: involuntary leakage of urine with effort
- Mixed incontinence: involuntary leakage associated with urgency and exertion
- Overactive bladder: urgency, frequency and nocturia with or without urge incontinence
- Incomplete emptying or overflow incontinence: dribbling and leakage associated with incomplete bladder emptying due to impaired detrusor contractions
Once a symptom has been identified, the patient will be further screened by a gynecologist. We will discuss her history, start a bladder diary and perform a physical examination, urinalysis and possibly an urodynamic test. We will clarify the exact type of incontinence she has and evaluate for any pelvic prolapse that may be associated with her symptoms.
Laboratory evaluation will involve a urinalysis and a post void residual volume test. The patient will be offered pelvic training with Kegel exercises and surgical options such as a bladder sling.
Prior to surgery, however, she will have urodynamic testing in our office.
We rarely refer to a specialist such as an urologist or urogynecologist unless the patient has the following: Hematuria in the absence of a urinary tract infection, suspected fistula or complex neurological conditions such as Parkinson’s disease or a spinal cord injury.
Pelvic Floor Prolapse and Urinary Incontinence
Dr. Miriam Mackovic - Basic talks about Pelvic Floor Prolapse and Urinary Incontinence