++

Urinary incontinence is the involuntary leakage of urine. It is a symptom that is often underreported by patients, and, therefore, is underdiagnosed and undertreated. It can have a significant impact on the quality of life of incontinent individuals, affecting their social, emotional, functional, and psychological well-being. There are many reversible causes of incontinence for which emergency physicians can initiate treatment and refer for specialty follow-up.

++

Physiology

++

Continence is maintained through a complex interplay of neurologic and muscular structures that keep intraurethral pressure higher than intravesical pressure (Table 108.1-1).

++
Table Graphic Jump Location
Table 108.1-1 Muscular and Neurologic Structures Contributing to Maintenance of Urinary Continence 
++

Clinical Features

++

The history, physical examination, and urinalysis are often sufficient to initiate treatment in the ED. The onset and course of symptoms, leakage frequency, associated symptoms, precipitating factors, and bowel and sexual function should be noted. The physical examination includes evaluation of cognitive and functional status, as well as neurologic and muscular, cardiovascular, abdominal, and vaginal examinations. Note the presence of any previous surgical scars. The differential diagnosis includes infection, systemic illness, neurologic disease, impaired cognition, and medication effects. Functional incontinence may be due to impaired cognition, mobility, manual dexterity, or environmental factors. Numerous medications also contribute to incontinence, especially in older individuals.

++

The most common types of urinary incontinence related to the lower urinary tract are listed in Table 108.1-2.

++
Table Graphic Jump Location
Table 108.1-2 Common Types of Lower Tract Urinary Incontinence 
++

Urge incontinence is related to uninhibited bladder contractions (detrusor muscle overactivity). Urge incontinence is seen in women of all ages but ...

Want access to your institution's subscription?

Sign in to your MyAccess Account while you are actively authenticated on this website via your institution (you will be able to tell by looking in the top right corner of any page – if you see your institution’s name, you are authenticated). You will then be able to access your institute’s content/subscription for 90 days from any location, after which you must repeat this process for continued access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess account, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessMedicine Full Site: One-Year Subscription

Connect to the full suite of AccessMedicine content and resources including more than 250 examination and procedural videos, patient safety modules, an extensive drug database, Q&A, Case Files, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessMedicine

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.