Urinary Incontinence (Female)
Diagnosis/Definition
Involuntary loss of urine that is bothersome to the patient.
Initial Diagnosis and Management
- Quantify the leakage and ask the patient how much this impacts her daily living (i.e. # of pads/day and whether leak is small or large amount). Leakage that is not bothersome to the patient does not require treatment.
- Urinanalysis and culture.
- Acute allergic and asthma symptoms causing sneezing/coughing should be maximally controlled.
- Gynecologic history: post or premenopausal/prior hysterectomy/salpingo-oophorectomy/estrogen replacement/dyspareunia.
- Bladder functions/frequency of voiding/normal sensation of filling and complete emptying/nocturia. Have the patient keep a three-day voiding diary including fluid intake (quantify), micturation, and notation of leaking episodes with events surrounding loss (urge, no sensation, etc.).
- A program of pelvic floor exercises.
Ongoing Management and Objectives
Improvement of involuntary loss of urine.
Indications for Specialty Care Referral
Patient request
If incontinence impacts daily living enough to warrant medical or surgical treatment
If patient has had a hysterectomy, refer to Urology
If the patient still has her uterus, refer to Uro-GYN.
Criteria for Return to Primary Care
After maximal medical or surgical benefit is obtained.
