Urinary incontinence differential diagnosis

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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

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