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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

  • 788.33 Mixed incontinence (male) (female)

  • 788.39 Other urinary incontinence

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ICD-10-CM Codes

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  • R32 Unspecified urinary incontinence

  • N39.46 Mixed incontinence

  • N39.498 Other specified urinary incontinence

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Preferred Practice Pattern

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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, combined with involuntary loss of urine control occurring during an increase in intra-abdominal pressure

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Essentials of Diagnosis

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  • High detrusor pressure in leakage episode during urodynamic testing, indicative of detrusor overactivity as well as urine leakage during increased intra-abominal pressure

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General Considerations

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  • Consideration of lower urinary tract infections

    • Sudden onset of symptoms

    • Urinary frequency

    • Urinary urgency

    • Lower back pain

  • Myogenic dysfunction of the detrusor

  • Urodynamic testing cannot be relied on to diagnosis overactive bladder (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

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  • Combined symptoms of stress and urge urinary incontinence

  • 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

  • Loss of urine without meaning to urinate during activities where there is an increase in intra-abdominal pressure (including sexual intercourse)

    • Coughing

    • Sneezing

    • Laughing

  • Loss of a small amount of urine preceded by an increase in intra-abdominal pressure but without a sensation or urge to urinate

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Functional Implications

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  • Increased risk for falls: 2- to 3.5-fold increase7-9

  • Increased risk of falls during an inpatient episode of care9

  • May lead to use of pads and/or wearing of diapers

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Possible Contributing Causes

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  • Underactive, overactive, or non-functioning pelvic floor muscles

  • Pelvic organ prolapse

  • Urethral hypermobility

  • Intrinsic sphincter deficiency

  • Bladder cancer

  • Bladder inflammation

  • Bladder stones

  • Spinal cord injury

  • Multiple sclerosis (MS)

  • Bladder obstruction from enlarged prostate

  • Benign Prostatic Hypertrophy (BPH)

  • Comorbidities such as diabetes

  • Urinary tract infections: bacterial

  • Increase in bladder sensation

  • Decrease in bladder capacity

  • Increase of detrusor overactivity

  • Reduction of maximal urethral closure pressure

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Differential Diagnosis

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