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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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  • R32 Unspecified urinary incontinence
  • N39.46 Mixed incontinence
  • N39.498 Other specified urinary incontinence

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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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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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  • Urinary tract infection (UTI)
  • Interstitial cystitis
  • Detrusor myopathy
  • Neuropathy

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Imaging

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  • Ultrasound imaging to identify abnormalities
    • Bladder
    • Urethra
    • Pelvis
    • Bladder neck position ...

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