Differential Diagnosis
Establish the type of urinary incontinence, after having eliminated reversible causes.
Stress incontinence
Definition: involuntary loss of urine that occurs during physical activity, coughing, sneezing, rising from a sitting position
- without pelvic floor muscle weakness
- attributable to a deficiency of the internal sphincter or to an anatomic deviation of the bladder neck
- particularly in women who have had a difficult childbirth or who suffer from hereditary collagen problems
- attributable to urethral instability
- with pelvic floor muscle weakness (deficiency of the external sphincter)
- attributable to sarcopenia, obesity, or recurrent pressure
Urge incontinence
Definition: a strong, sudden need to urinate accompanied by involuntary urine loss
- attributable to factors such as age or idiopathic
- attributable to damage to the inhibiting central tract:
- frontal stroke, Parkinson's
disease, tumour, normal pressure hydrocephalus
- attributable to localized bladder irritation:
- stones, polyps, cancer, cystitis
- attributable to pelvic floor muscle weakness associated with excess consumption of caffeinated drinks (often along with difficulty walking)
Overflow incontinence
Definition: involuntary loss of urine associated with bladder overdistention in the absence of detrusor contraction.
- vesical obstruction at exit:
- in women: large cystocele or prolapse, stenosis
following surgery or radiotherapy.
- detrusor dysfunction:
- injury to the spinal cord, metastasis of the spinal cord, spinal stenosis
- anticholinergic medication
Mixed incontinence
Definition: usually a combination of both stress and urge urinary incontinence
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