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==Differential diagnosis==
==Differential diagnosis==
Urinary incontinence may have different etiologies depending upon the underlying dysfunction. The various types of urinary incontinence should be differentiated from each other for optimal management. The following table differentiates the various types of urinary incontinence:<ref name="urlpdfs.semanticscholar.org">{{cite web |url=https://pdfs.semanticscholar.org/0a01/f4ccaf0d943bd1d8d009b9d9ae6de1260511.pdf |title=pdfs.semanticscholar.org |format= |work= |accessdate=}}</ref><ref name="pmid16702587">{{cite journal |vauthors=Brown JS, Bradley CS, Subak LL, Richter HE, Kraus SR, Brubaker L, Lin F, Vittinghoff E, Grady D |title=The sensitivity and specificity of a simple test to distinguish between urge and stress urinary incontinence |journal=Ann. Intern. Med. |volume=144 |issue=10 |pages=715–23 |date=May 2006 |pmid=16702587 |pmc=1557357 |doi= |url=}}</ref><ref name="pmid18364487">{{cite journal |vauthors=Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE |title=What type of urinary incontinence does this woman have? |journal=JAMA |volume=299 |issue=12 |pages=1446–56 |date=March 2008 |pmid=18364487 |doi=10.1001/jama.299.12.1446 |url=}}</ref><ref name="pmid9611005">{{cite journal |vauthors=Videla FL, Wall LL |title=Stress incontinence diagnosed without multichannel urodynamic studies |journal=Obstet Gynecol |volume=91 |issue=6 |pages=965–8 |date=June 1998 |pmid=9611005 |doi= |url=}}</ref><ref name="pmid20025027">{{cite journal |vauthors=DuBeau CE, Kuchel GA, Johnson T, Palmer MH, Wagg A |title=Incontinence in the frail elderly: report from the 4th International Consultation on Incontinence |journal=Neurourol. Urodyn. |volume=29 |issue=1 |pages=165–78 |date=2010 |pmid=20025027 |doi=10.1002/nau.20842 |url=}}</ref><ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html#afp20130415p543-b6 |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref><ref name="pmid21075990">{{cite journal |vauthors=Frank C, Szlanta A |title=Office management of urinary incontinence among older patients |journal=Can Fam Physician |volume=56 |issue=11 |pages=1115–20 |date=November 2010 |pmid=21075990 |pmc=2980426 |doi= |url=}}</ref><ref name="pmid16985854">{{cite journal |vauthors=Imam KA |title=The role of the primary care physician in the management of bladder dysfunction |journal=Rev Urol |volume=6 Suppl 1 |issue= |pages=S38–44 |date=2004 |pmid=16985854 |pmc=1472846 |doi= |url=}}</ref>
Urinary incontinence may have different etiologies depending upon the underlying dysfunction. The various types of urinary incontinence should be differentiated from each other for optimal management. The following table differentiates the various types of urinary incontinence:<ref name="urlpdfs.semanticscholar.org">{{cite web |url=https://pdfs.semanticscholar.org/0a01/f4ccaf0d943bd1d8d009b9d9ae6de1260511.pdf |title=pdfs.semanticscholar.org |format= |work= |accessdate=}}</ref><ref name="pmid16702587">{{cite journal |vauthors=Brown JS, Bradley CS, Subak LL, Richter HE, Kraus SR, Brubaker L, Lin F, Vittinghoff E, Grady D |title=The sensitivity and specificity of a simple test to distinguish between urge and stress urinary incontinence |journal=Ann. Intern. Med. |volume=144 |issue=10 |pages=715–23 |date=May 2006 |pmid=16702587 |pmc=1557357 |doi= |url=}}</ref><ref name="pmid18364487">{{cite journal |vauthors=Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE |title=What type of urinary incontinence does this woman have? |journal=JAMA |volume=299 |issue=12 |pages=1446–56 |date=March 2008 |pmid=18364487 |doi=10.1001/jama.299.12.1446 |url=}}</ref><ref name="pmid9611005">{{cite journal |vauthors=Videla FL, Wall LL |title=Stress incontinence diagnosed without multichannel urodynamic studies |journal=Obstet Gynecol |volume=91 |issue=6 |pages=965–8 |date=June 1998 |pmid=9611005 |doi= |url=}}</ref><ref name="pmid20025027">{{cite journal |vauthors=DuBeau CE, Kuchel GA, Johnson T, Palmer MH, Wagg A |title=Incontinence in the frail elderly: report from the 4th International Consultation on Incontinence |journal=Neurourol. Urodyn. |volume=29 |issue=1 |pages=165–78 |date=2010 |pmid=20025027 |doi=10.1002/nau.20842 |url=}}</ref><ref name="urlDiagnosis of Urinary Incontinence - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2013/0415/p543.html#afp20130415p543-b6 |title=Diagnosis of Urinary Incontinence - American Family Physician |format= |work= |accessdate=}}</ref><ref name="pmid21075990">{{cite journal |vauthors=Frank C, Szlanta A |title=Office management of urinary incontinence among older patients |journal=Can Fam Physician |volume=56 |issue=11 |pages=1115–20 |date=November 2010 |pmid=21075990 |pmc=2980426 |doi= |url=}}</ref><ref name="pmid16985854">{{cite journal |vauthors=Imam KA |title=The role of the primary care physician in the management of bladder dysfunction |journal=Rev Urol |volume=6 Suppl 1 |issue= |pages=S38–44 |date=2004 |pmid=16985854 |pmc=1472846 |doi= |url=}}</ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="2" rowspan="5" |Diseases
| rowspan="5" |Type of incontinence
| colspan="10" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="6" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| colspan="1" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
| colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Loss of consciousness
! colspan="1" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinary symptoms
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hypertension
! colspan="1" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pitting edema
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Neurological deficit
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urine residue
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinalysis
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasonography
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Frequency
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dribbling
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nocturia
|-
! rowspan="6" |[[Neurological disorders|Neurological diseases]]
![[Stroke]]
!Urge and Stress
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
|-
![[Alzheimer's disease]]
!Urge and Stress
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
|-
![[Parkinson's disease]]
!Urge and Stress
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
|-
![[Altered mental status]]
!Functional
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
|-
![[Spinal cord injury|Traumatic spinal cord injury]]
!Stress 
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
|-
![[Multiple sclerosis|Multiple sclerosis (MS)]]
!Urge and Overflow
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
|-
! rowspan="5" |[[Urogenital malformation|Urogenital disorders]]
![[Benign prostatic hyperplasia|Benign prostatic hyperplasia (BPH)]]
!Urge and Overflow
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
|-
![[Genitourinary system|Genitourinary]] [[surgical procedures]]
!Urge and Stress
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
|-
![[Childbirth|Multiple childbirths]]
!Urge and Stress
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
|-
![[Uterine fibroids]]
!Overflow
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
|-
![[Uterine prolapse]]
!Stress 
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
|-
! rowspan="2" |[[Gastrointestinal diseases]]
![[Fecal impaction]]
!Overflow
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
|-
![[Rectal prolapse]]
!Overflow
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
|}
{| class="wikitable"
{| class="wikitable"
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Type Of Incontinence
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Type Of Incontinence

Revision as of 14:58, 10 May 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Differential diagnosis

Urinary incontinence may have different etiologies depending upon the underlying dysfunction. The various types of urinary incontinence should be differentiated from each other for optimal management. The following table differentiates the various types of urinary incontinence:[1][2][3][4][5][6][7][8]

Diseases Type of incontinence Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging
Loss of consciousness Fever Abdominal pain Urinary symptoms Hypertension Pitting edema Neurological deficit Urine residue Urinalysis Other Ultrasonography CT scan Other
Dysuria Frequency Dribbling Nocturia
Neurological diseases Stroke Urge and Stress
Alzheimer's disease Urge and Stress
Parkinson's disease Urge and Stress
Altered mental status Functional
Traumatic spinal cord injury Stress 
Multiple sclerosis (MS) Urge and Overflow
Urogenital disorders Benign prostatic hyperplasia (BPH) Urge and Overflow
Genitourinary surgical procedures Urge and Stress
Multiple childbirths Urge and Stress
Uterine fibroids Overflow
Uterine prolapse Stress 
Gastrointestinal diseases Fecal impaction Overflow
Rectal prolapse Overflow
Type Of Incontinence Causes Prevalence Pathophysiology History Findings Signs and symptoms Management
Urgency Frequency

(> 8 times/day)

Dribbling of urine Amount of dribbling with each episode of incontinence Ability hold urge Nocturia Post-void residual volume
Urge incontinence (detrusor instability)
  • Stroke
  • Alzheimer's disease
  • Parkinson's disease
  • Benign prostatic hyperplasia (BPH)
  • 9% in women age 40-44 years
  • 31% in women older than 75 years
  • 42% in men older than 75 years
  • Detrusor overactivity
  • Increased parasympathetic drive to the bladder (S2-S4)
  • Variable amount of urine loss; ranging from small volumes to complete emptying of the bladder
 + + -
  • Small to large volume
 - ++ < 50 ml
  • Pelvic floor excercises
  • Oxybutynin
  • Tolterodine
Stress incontinence
  • Genitourinary surgical procedures
  • Multiple childbirths
  • 25-45% in women > 30 years
  • Weakness of the uretheral sphincter
  • Weakness of the pelvic floor muscles
  • Patient recognizes which activities promote incontinence
  • Incontinence with cough, sneezing, straining
 - - +
  • Small volume
 + +/- < 50 ml
  • Pelvic floor excercises
  • Alpha agonists
  • Topical estrogen cream
Overflow incontinence
  • Benign prostatic hyperplasia
  • Fecal impaction
  • 5% of patients with chronic incontinence
  • More common in males
  • Overdistension of the bladder
  • Impaired bladder contractility
  • Bladder outlet obstruction (BOO)
  • Poor bladder emptying
  • Post-void urine volume > 200-300 ml
 - - +
  • Small volume
 + + > 200 ml
  • Alpha-adrenergic blockers:
    • Tamsulosin
    • Terazosin
  • Catheterization
  • Diversion
Mixed incontinence (urge and stress)
  • Stroke
  • Alzheimer's disease
  • Parkinson's disease
  • Benign prostatic hyperplasia (BPH)
  • Genitourinary surgical procedures
  • Multiple childbirths
 -
  • Combined urge and stress incontinence
  • Patient able to determine the pre-dominant symptoms
 + +/- +
  • Variable volume
 +/- +/- Variable
  • Symptomatic management
Functional incontinence
  • Altered mental status
 -
  • Inability to reach the toilet to urinate
  • Environmental barriers
  • Physical barriers
  • Immobility
  • Lower urinary tract deficits
 - - +
  • Variable volume
 + + < 50 ml
  • Cause-dependent

References

  1. ↑ "pdfs.semanticscholar.org" (PDF).
  2. ↑ Brown JS, Bradley CS, Subak LL, Richter HE, Kraus SR, Brubaker L, Lin F, Vittinghoff E, Grady D (May 2006). "The sensitivity and specificity of a simple test to distinguish between urge and stress urinary incontinence". Ann. Intern. Med. 144 (10): 715–23. PMC 1557357. PMID 16702587.
  3. ↑ Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE (March 2008). "What type of urinary incontinence does this woman have?". JAMA. 299 (12): 1446–56. doi:10.1001/jama.299.12.1446. PMID 18364487.
  4. ↑ Videla FL, Wall LL (June 1998). "Stress incontinence diagnosed without multichannel urodynamic studies". Obstet Gynecol. 91 (6): 965–8. PMID 9611005.
  5. ↑ DuBeau CE, Kuchel GA, Johnson T, Palmer MH, Wagg A (2010). "Incontinence in the frail elderly: report from the 4th International Consultation on Incontinence". Neurourol. Urodyn. 29 (1): 165–78. doi:10.1002/nau.20842. PMID 20025027.
  6. ↑ "Diagnosis of Urinary Incontinence - American Family Physician".
  7. ↑ Frank C, Szlanta A (November 2010). "Office management of urinary incontinence among older patients". Can Fam Physician. 56 (11): 1115–20. PMC 2980426. PMID 21075990.
  8. ↑ Imam KA (2004). "The role of the primary care physician in the management of bladder dysfunction". Rev Urol. 6 Suppl 1: S38–44. PMC 1472846. PMID 16985854.

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