Urge urinary incontinence (UUI)

• Detrusor instability (DI)
• Detrusor overactivity incontinence
• Overactive bladder (OAB)
• Overactive bladder syndrome
• Urge syndrome
• Urgency-frequency syndrome

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

• N39.41 Urge incontinence
• R32 Unspecified urinary incontinence

• 4C impaired muscle performance1

Description

• Involuntary loss of urine control accompanied by or immediately preceded by urgency

General Considerations

• 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

Demographics

• 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

Signs and Symptoms

• 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

Functional Implications

• Increased risk for falls: 2- to 3.5-fold increase8,23,25
• Increased risk of falls during an inpatient episode of care25

Possible Contributing Causes

• 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

Differential Diagnosis

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

Imaging

• 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

Diagnostic Procedures

• 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 ...