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  • Genuine stress incontinence (GSI)

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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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  • 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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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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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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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 (3IQ):
    • Sensitivity of .86
    • Specificity of .607
  • Urethral pressure profile: study of intraluminal pressure along the length of the urethra via pressure sensitive catheter
  • Leak point pressure profile: dynamic study of urethral pressure during activity

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  • Leak during valsalva maneuver or cough during ...

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