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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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  • 788.3 Urinary incontinence
  • 788.30 Urinary incontinence, unspecified
  • 788.31 Urge Incontinence

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  • N39.41 Urge incontinence
  • R32 Unspecified urinary incontinence

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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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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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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 test
    • Stand with a full bladder and cough
    • Test does not have good reliability or validity
    • Test is not specific enough to rule in/out a diagnosis
  • Urodynamics: functional study of the lower urinary tract
    • Indications include: unclear cause of voiding dysfunction, incontinence unresponsive to conservative treatment, ...

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