Urinary incontinence differential diagnosis

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References

Type Of Incontinence Causes Prevalence Pathophysiology History Findings Signs and symptoms
Urgency Frequency

(> 8 times/day)

Dribbling of urine Amount of dribbling with each episode of incontinence Ability hold urge Nocturia
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
+ + -
  • Large volume
- ++
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
+ +/-
Overflow incontinence
  • Benign prostatic hyperplasia
  • Fecal impaction
  • 5% of patients with chronic incontinence
  • Overdistension of the bladder
  • Impaired bladder contractility
  • Bladder outlet obstruction (BOO)
  • Poor bladder emptying
  • Post-void urine volume > 200-300 ml
- - +
  • Small volume
+ +
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
+/- +/-
Functional incontinence
  • Altered mental status
-
  • Inability to reach the toilet to urinate
  • Environmental barriers
  • Physical barriers
  • Immobility
  • Lower urinary tract deficits
- - +
  • Variable volume
+ +

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