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Incontinence (History (Stress incontinence: leakage of urine on sneezing,…
Incontinence
History
Stress incontinence: leakage of urine on sneezing, coughing, exercise, rising from sitting, or lifting.
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When assessing urinary incontinence in neurological disease, consider factors likely to affect management, such as mobility, hand co-ordination, cognitive function, social support and lifestyle
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The patient should be asked, during their initial assessment, to complete a bladder chart for a minimum of three days. These should include both working days and days off.
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Types
Functional incontinence: the patient is unable to reach the toilet in time, for such reasons as poor mobility or unfamiliar surroundings.
Stress incontinence: involuntary leakage of urine on effort or exertion, or on sneezing or coughing. This is due to an incompetent sphincter. Stress incontinence may be associated with genitourinary prolapse.
Urge incontinence: involuntary urine leakage accompanied by, or immediately preceded by, urgency of micturition. This means a sudden and compelling desire to urinate that cannot be deferred. In urge incontinence there is detrusor instability or hyperreflexia leading to involuntary detrusor contraction. This may be idiopathic or secondary to neurological problems such as stroke, Parkinson's disease, multiple sclerosis, dementia or spinal cord injury. It can sometimes be caused by local irritation due to infection or bladder stones.
Mixed incontinence: involuntary leakage of urine associated with both urgency and exertion, effort, sneezing or coughing.
Overactive bladder syndrome: urgency that occurs with or without urge incontinence and usually with frequency and nocturia. It may be called 'OAB wet' or 'OAB dry', depending on whether or not the urgency is associated with incontinence. The usual cause of this problem is detrusor overactivity. See the separate Overactive Bladder article.
Overflow incontinence: usually due to chronic bladder outflow obstruction. It is often due to prostatic disease in men. It can lead to obstructive nephropathy due to back pressure; therefore, early assessment and intervention are required. See the separate Acute Urinary Retention and Chronic Urinary Retention articles. Overflow incontinence may also be due to a neurogenic bladder.
True incontinence/total: may be due to a fistulous track between the vagina and the ureter, or bladder, or urethra. There is continuous leakage of urine
neurogenic bladder: incontinence following on from eg spinal cord injury, MS
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treatment options
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BPH
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enlarged prostate
steroid 5a reductase eg dutasteride, finasteride
Examination
Women
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Perform a bimanual/vaginal examination to assess for the presence of prolapse. See the separate Genitourinary Prolapse article.
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Abdominal, pelvic and neurological examination should also be performed
Men
Perform digital rectal examination to assess prostate shape, size and consistency and to check for other rectal pathology.
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Abdominal, pelvic and neurological examination should also be performed
When to Refer
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Men
If there are any criteria present that meet the two-week suspected cancer referral in men, appropriate referral should be made.
NICE recommends referral for men with LUTS complicated by recurrent or persistent UTI, retention, renal impairment that is suspected to be caused by lower urinary tract dysfunction, or suspected urological cancer.