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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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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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General Considerations

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  • Consideration of lower urinary tract infections: 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 diagnosis18

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Demographics

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  • Urinary incontinence affects 30% to 60% of middle-aged and older women14, 20

  • Urinary incontinence reported by 78% of women with low back pain10

  • Severe urinary incontinence is more prevalent in later years

  • 30% to 52% of homebound elderly suffer from urinary incontinence13

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Clinical Findings

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Signs and Symptoms

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  • 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 increase8,23,25

  • Increased risk of falls during an inpatient episode of care25

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Possible Contributing Causes

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

  • 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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  • Urinary tract infection (UTI)

  • Interstitial cystitis

  • Detrusor myopathy

  • Neuropathy

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Means of Confirmation or Diagnosis

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Imaging

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  • Ultrasound imaging to identify abnormalities of the bladder, urethra or pelvis, bladder neck position and mobility, pelvic floor function, activity of levator ani, descent of pelvic organs, and 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

  • Urinary stress ...

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