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CONDITION/DISORDER SYNONYMS

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  • Detrusor instability (DI)

  • Detrusor overactivity incontinence

  • Overactive bladder (OAB)

  • Overactive bladder syndrome

  • Urge syndrome

  • Urgency-frequency syndrome

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ICD-9-CM CODES

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  • 788.3 Urinary incontinence

  • 788.30 Urinary incontinence, unspecified

  • 788.31 Urge Incontinence

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ICD-10-CM CODES

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  • N39.41 Urge incontinence

  • R32 Unspecified urinary incontinence

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PREFERRED PRACTICE PATTERN

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  • 4C: Impaired Muscle Performance1

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PATIENT PRESENTATION

A 45-year-old woman reports that several times per day she experiences a sudden strong urge to urinate and cannot make it to the bathroom without leaking. She has noticed the gradual increase in frequency and urgency of urination over the past few years. Now she is also waking up three to four times per night to urinate. She is wearing three pads per day and sometimes wets through the pad and her clothes are wet. She has stopped participating in the cross-fit classes that she enjoys, because she is leaking. She is afraid to go to the symphony with her husband because of these symptoms.

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KEY FEATURES

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Description
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  • Involuntary loss of urine control accompanied by or immediately preceded by urgency

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Essentials of Diagnosis
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  • High detrusor pressure during urodynamic testing indicative of detrusor overactivity contributing to urge urinary incontinence (UUI)

  • 3 Incontinence Questions (3IQ): Sensitivity of 0.75, specificity of 0.77, and a positive likelihood ratio of 3.29 for the classification of UUI

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General Considerations
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  • Consideration of lower urinary tract infections (UTIs): Urinary frequency, urinary urgency, lower back pain

  • Myogenic dysfunction of the detrusor

  • Urodynamic testing cannot be relied on to diagnose OAB but can be used to confirm the diagnosis2

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Demographics
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  • Urinary incontinence affects 30% to 60% of middle-aged and older women3,4

  • Urinary incontinence reported by 78% of women with low back pain5

  • Severe urinary incontinence is more prevalent in later years

  • 30% to 52% of homebound elderly suffer from urinary incontinence6

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CLINICAL FINDINGS

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SIGNS AND SYMPTOMS

  • More than seven voids per 24 hours

  • Loss of urine without meaning to urinate

  • Loss of a moderate to large amount of urine preceded by an urge to urinate, often associated with an irritant such as running water, walking by the bathroom, putting a key in a lock, or nervousness

  • Increased alpha tone in prostatic and urethral smooth muscle

  • Inflammation in the bladder

  • Sensitivity to potassium

  • Possible triggering of the micturition reflex

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Functional Implications
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  • Increased risk for falls: 2- to 3.5-fold increase79

  • Increased risk of falls during an inpatient episode of care9

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Possible Contributing Causes
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  • Underactive, overactive, or nonfunctioning pelvic floor muscles

  • Bladder cancer

  • Bladder inflammation

  • Bladder stones

  • Spinal cord injury

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