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Condition/Disorder Synonym

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  • Genuine stress incontinence (GSI)

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ICD-9-CM Codes

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  • 623.9 Female stress urinary incontinence

  • 788.30 Urinary incontinence, unspecified

  • 788.34 Incontinence without sensory awareness

  • 788.39 Other urinary incontinence

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ICD-10-CM Codes

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  • N39.3 Stress incontinence (female) (male)

  • N39.42 Incontinence without sensory awareness

  • N39.49 Other specified urinary incontinence

  • R32 Unspecified 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 occurring during an increase in intra-abdominal pressure

  • Urinary sphincter muscles are not able to prevent urine flow during episode of intra-abdominal pressure

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Essentials of Diagnosis

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  • Urinary stress test or cough test

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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

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Demographics

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  • Urinary incontinence affects 30% to 60% of middle-aged and older women and 22% of men2-4

  • 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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  • 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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  • 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 prolapsed

  • Urethral hypermobility

  • Intrinsic sphincter deficiency

  • Bladder cancer

  • Bladder inflammation

  • Bladder stones

  • Benign Prostatic Hypertrophy (BPH)

  • Comorbidities such as diabetes, stroke, hip replacement

  • Urinary tract infections: bacterial

  • Reduction of maximal urethral closure pressure

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Differential Diagnosis

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  • Urinary tract infection (UTI)

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Means of Confirmation or Diagnosis

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Imaging

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  • Ultrasound imaging to identify abnormalities

    • Bladder

    • Urethra

    • Pelvis

    • Bladder neck position and mobility

    • Pelvic floor function

    • Activity of levator ani

    • Descent of pelvic organs

    • Sphincter integrity

  • MRI to examine soft tissue structures of the pelvic support apparatus

  • Pelvic/abdominal ultrasound

    • Measure bladder capacity

    • Rule out other pathologies

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Diagnostic Procedures

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  • Rule out urinary tract infection (UTI)

  • Post-void residual volume (PVR): measures amount of urine left after urinating

  • Urodynamics: functional study of the lower urinary tract

    • Indications include: unclear cause of voiding dysfunction, incontinence unresponsive to conservative treatment, history of hysterectomy, bladder surgeries or pelvic organ prolapse procedures, neurological conditions

    • Assess sphincter competency

  • Three incontinence questions ...

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