Urinary incontinence differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2], Syed Hassan A. Kazmi BSc, MD [3]

Overview

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.

Differential diagnosis of urinary incontinence

The following table differentiates the various types of urinary incontinence:[1][2][3][4][5][6][7][8]

To review differential diagnosis of urge urinary incontinence, click here.

To review differential diagnosis of stress urinary incontinence, click here.

To review differential diagnosis of functional urinary incontinence, click here.

To review differential diagnosis of overflow urinary incontinence, click here.

To review differential diagnosis of mixed urinary incontinence, click here.

Category Diseases Type of incontinence Clinical manifestations Lab Findings Gold standard Associated findings
Symptoms Signs
Loss of consciousness Fever Pelvic pain Urinary symptoms Blood Pressure Neurological deficit Urine residue UA Other
Urge Stress Overflow Functional Dysuria Frequency Dribbling Nocturia
Neurological diseases Stroke[9] + + ± + ± + + ++ ↑/↓ + < 50 ml Pyuria ± NA Imaging
Alzheimer's disease[10][11] + + + + ± ± + + ++ Nl + < 50 ml Pyuria ± NA Clinical manifestations
Parkinson's disease[12][13] + ± + + ++ Nl to ↓ + < 50 ml Nl NA Clinical manifestations
Traumatic spinal cord injury[14] + + + ± Nl to ↓ + < 50 ml Nl NA MRI of spine
Normal pressure hydrocephalus[15] + + + Nl + > 200 ml Nl NA Cerebrospinal fluid (CSF) removal test
  • Slowly progressive gait abnormalities (Magnetic gait)
  • Cognitive deterioration (Dementia)
Multiple sclerosis[16] + + + + + Nl to ↓ + > 200 ml Nl NA MRI of brain and spine
  • Optic neuritis 
  • Sensory and motor abnormalities
  • Relapses and remission
Category Diseases Urge Stress Overflow Functional Loss of consciousness Fever Pelvic pain Dysuria Frequency Dribbling Nocturia Blood Pressure Neurological deficit Urine residue UA Other Gold standard Additional findings
Urogenital disorders Benign prostatic hyperplasia[17] + + + + ± + ++ + Nl to ↑ > 200 ml Hematuria Elevated PSA (less than 4 ng/dL) Digital rectal examination
Genitourinary surgical procedures[18][19] + + ± + + + + Depends on underlying disease < 50 ml Nl NA Clinical manifestations
Multiple childbirths[20][21] + + ± + + + Nl < 50 ml Nl NA Clinical manifestations
  • Increased risk in vaginal delivery
  • More common in obese patients
Uterine fibroids[22] + + + + + Nl > 200 ml Nl NA Clinical manifestations+ imaging
Uterine prolapse[23] + + + + + ± Nl < 50 ml Nl NA Pelvic examination
Vesicovaginal fistula[24] + + + + + Nl < 50 ml Nl NA Pelvic examination
Bladder cancer[25] + + ± + + + + Nl > 200 ml Hematuria NA Biopsy
Gastrointestinal diseases Fecal impaction[26] + + + + + Nl > 200 ml Pyuria ↑ K+ Digital rectal examination
Rectal prolapse[27] + + + + Nl > 200 ml Pyuria NA Pelvic examination
Category Diseases Urge Stress Overflow Functional Loss of consciousness Fever Pelvic pain Dysuria Frequency Dribbling Nocturia Blood Pressure Neurological deficit Urine residue UA Other Gold standard Additional findings

References

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  16. Bosch, JLH Ruud; Groen, Jan (1996). "Treatment of refractory urge urinary incontinence with sacral spinal nerve stimulation in multiple sclerosis patients". The Lancet. 348 (9029): 717–719. doi:10.1016/S0140-6736(96)04437-6. ISSN 0140-6736.
  17. Peters, T.J.; Donovan, J.L.; Kay, H.E.; Abrams, P.; de la Rosette, J.J.M.C.H.; Porru, D.; Thuroff, J.W. (1997). "The International Continence Society "Benign Prostatic Hyperplasia" Study: The Bothersomeness of Urinary Symptoms". The Journal of Urology. 157 (3): 885–889. doi:10.1016/S0022-5347(01)65075-4. ISSN 0022-5347.
  18. Altman, Daniel; Granath, Fredrik; Cnattingius, Sven; Falconer, Christian (2007). "Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study". The Lancet. 370 (9597): 1494–1499. doi:10.1016/S0140-6736(07)61635-3. ISSN 0140-6736.
  19. Prabhu, Vinay; Sivarajan, Ganesh; Taksler, Glen B.; Laze, Juliana; Lepor, Herbert (2014). "Long-term Continence Outcomes in Men Undergoing Radical Prostatectomy for Clinically Localized Prostate Cancer". European Urology. 65 (1): 52–57. doi:10.1016/j.eururo.2013.08.006. ISSN 0302-2838.
  20. Barbosa L, Boaviagem A, Moretti E, Lemos A (May 2018). "Multiparity, age and overweight/obesity as risk factors for urinary incontinence in pregnancy: a systematic review and meta-analysis". Int Urogynecol J. doi:10.1007/s00192-018-3656-9. PMID 29754281.
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  22. Dragomir, Anca D.; Schroeder, Jane C.; Connolly, AnnaMarie; Kupper, Larry L.; Cousins, Deborah S.; Olshan, Andrew F.; Baird, Donna D. (2010). "Uterine Leiomyomata Associated with Self-Reported Stress Urinary Incontinence". Journal of Women's Health. 19 (2): 245–250. doi:10.1089/jwh.2009.1396. ISSN 1540-9996.
  23. de Boer TA, Salvatore S, Cardozo L, Chapple C, Kelleher C, van Kerrebroeck P, Kirby MG, Koelbl H, Espuna-Pons M, Milsom I, Tubaro A, Wagg A, Vierhout ME (2010). "Pelvic organ prolapse and overactive bladder". Neurourol. Urodyn. 29 (1): 30–9. doi:10.1002/nau.20858. PMID 20025017.
  24. Reisenauer C (August 2015). "Vesicovaginal fistulas: a gynecological experience in 41 cases at a German pelvic floor center". Arch. Gynecol. Obstet. 292 (2): 245–53. doi:10.1007/s00404-015-3760-8. PMID 26001626.
  25. Porter, M; Penson, D (2005). "HEALTH RELATED QUALITY OF LIFE AFTER RADICAL CYSTECTOMY AND URINARY DIVERSION FOR BLADDER CANCER: A SYSTEMATIC REVIEW AND CRITICAL ANALYSIS OF THE LITERATURE". The Journal of Urology. 173 (4): 1318–1322. doi:10.1097/01.ju.0000149080.82697.65. ISSN 0022-5347.
  26. Loening-Baucke, V. (1997). "Urinary Incontinence and Urinary Tract Infection and Their Resolution With Treatment of Chronic Constipation of Childhood". PEDIATRICS. 100 (2): 228–232. doi:10.1542/peds.100.2.228. ISSN 0031-4005.
  27. González-Argenté, Xavier F.; Jain, Anil; Nogueras, Juan J.; Davila, Willy G.; Weiss, Eric G.; Wexner, Steven D. (2001). "Prevalence and severity of urinary incontinence and pelvic genital prolapse in females with anal incontinence or rectal prolapse". Diseases of the Colon & Rectum. 44 (7): 920–925. doi:10.1007/BF02235476. ISSN 0012-3706.

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