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271: MIXED URINARY INCONTINENCE

Stephanie Bush, DPT, MEd, WCS; Cynthia E. Neville, DPT, PT, WCS; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Unspecified urinary incontinence (UUI)

  • None

ICD-9-CM CODES

  • 788.3 Urinary incontinence

  • 788.30 Urinary incontinence, unspecified

  • 788.31 Urge incontinence

  • 788.33 Mixed urinary incontinence

  • 788.39 Other urinary incontinence

ICD-10-CM CODES

  • R32 Unspecified urinary incontinence

  • N39.46 Mixed urinary incontinence

  • N39.498 Other specified urinary incontinence

PREFERRED PRACTICE PATTERN

  • 4C: Impaired Muscle Performance1

PATIENT PRESENTATION

A 50-year-old woman reports that she has occasionally leaked urine during coughing, sneezing, and jumping rope over the past 10 years. She thought it was “no big deal” and that it was “normal” after having children. She always wore a panty liner and so she never made her clothes wet. She would just change the liner. Lately, she experiences a sudden strong urge to urinate and cannot make it to the bathroom without leaking. When she leaks, the liner is soaked and sometimes wets her clothes. She has noticed a gradual increase in frequency and urgency of urination over the past few years. Now she wakes up 3 to 4 times per night to urinate. Sometimes in the middle of the night she cannot get to the bathroom and wets her pants.

KEY FEATURES

Description

  • 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

Essentials of Diagnosis

  • High detrusor pressure during leakage episode during urodynamic testing indicative of detrusor overactivity as well as urine leakage during increased intra-abdominal pressure

General Considerations

  • Consideration of lower urinary tract infections (UTIs)

    • Sudden onset of symptoms

    • Urinary frequency

    • Urinary urgency

    • Lower back pain

  • Myogenic dysfunction of the detrusor

  • Urodynamic testing cannot be relied on to diagnose overactive bladder (OAB) but can be used to confirm the diagnosis2

Demographics

  • Urinary incontinence (UI) affects 30% to 60% of middle-aged and older women.3,4

  • UI reported by 78% of women with low back pain.5

  • Severe UI is more prevalent in later years.

  • 30% to 52% of homebound elderly suffer from UI.6

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Combined symptoms of stress and urge UI

  • 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 ...

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