Mixed urinary incontinence (UUI)

• 788.3 Urinary incontinence
• 788.30 Urinary incontinence, unspecified
• 788.31 Urge Incontinence
• 788.33 Mixed incontinence (male) (female)
• 788.39 Other urinary incontinence

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

• Pattern 4C: impaired muscle performance1

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 in leakage episode during urodynamic testing, indicative of detrusor overactivity as well as urine leakage during increased intra-abominal pressure

General Considerations

• 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

Demographics

• 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

Signs and Symptoms

• 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

Functional Implications

• 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

Possible Contributing Causes

• 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

Differential Diagnosis

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

Imaging

• Ultrasound imaging ...