Guideline sources The following summarized guidelines for the management of urinary incontinence in women (UI) are prepared by our editorial team based on guidelines from the American College of Physicians (ACP 2014). 1 2 2 3 4 5 6 Definition Urinary incontinence is defined as involuntary or abnormal leakage of urine. 2 Epidemiology Urinary incontinence has multiple possible causes, including age-related functional changes (overactive detrusor, impaired bladder contractility, decreased pressure in urethra closure, atrophy of urethral areas, prostatic hypertrophy), lesions in the CNS, excess urine output, restricted mobility, stool impaction, UTI, delirium, and medications (alpha-adrenergic agonists, alpha-adrenergic antagonists, anticholinergics, cancer drugs, calcium-channel blockers, diuretics, opiates, sedatives). 2 Pathophysiology The prevalence of any symptom urinary incontinence is high in the adult population, with an estimated age-standardized prevalence of 51.1% in women and 13.9%, in men respectively. 3 Disease course Clinical manifestations include urine leakage and, depending on the etiology, associated LUTS of urgency, frequency, nocturia, weak urination, and incomplete emptying associated. 4 P i d i k f https://web.pathway.md/diseases/recIQCZOhn8GVw9eC 1/4 6/29/23, 3:49 AM Urinary incontinence in women Pathway Prognosis and risk of recurrence Urinary incontinence is a predictor of death in the general population and geriatric population. Urinary incontinence is associated with psychological morbidity and may lead to substantial impairment of quality of life. 5 6 Calculator Revised Urinary Incontinence Sc Guidelines 1. Medical management Pharmacological treatment: Avoid initiating systemic pharmacologic therapy in patients with stress urinary incontinence. D Initiate pharmacologic treatment in women with urgency urinary incontinence if bladder training was unsuccessful. Select a pharmacologic agent based on tolerability, adverse effect profile, ease of use, and cost of medication. A 2. Nonpharmacologic interventions Bladder training: consider bladder training in women with urgency urinary incontinence. C Pelvic floor muscle training: Advise pelvic floor muscle training in women with stress urinary incontinence. A Advise pelvic floor muscle training with bladder training in women with mixed urinary incontinence. A Weight loss and exercises: advise weight loss and exercise for obese women with urinary incontinence. B Clinical findings Patient demographics Symptoms Female sex Involuntary leakage of urine Past medical history Past obstetric history Induced with cough Childbirth Menopause Pregnancy Obesity Social history https://web.pathway.md/diseases/recIQCZOhn8GVw9eC 2/4 6/29/23, 3:49 AM Urinary incontinence in women Pathway Current cigarette smoking Past surgical history Hysterectomy Genitourinary exam Likelihood Ratios Pertinent positives The following findings increase the probability of stress incontinence in women with urinary incontinence. 6 Finding LR+ Value Positive bladder stress test 3.1 (1.7-5.5) Pertinent negatives The following findings decrease the probability of stress incontinence in women with urinary incontinence. 6 Finding LR- Value Negative bladder stress test 0.36 (0.21-0.60) References 1. Qaseem A, Dallas P, Forciea MA et al. Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014 Sep 16;161 6 429 40. Open 2. Demaagd GA, Davenport TC. Management of urinary incontinence. P T. 2012 Jun;37 6 345 361H. Open 3. Markland AD, Richter HE, Fwu CW et al. Prevalence and trends of urinary incontinence in adults in the United States, 2001 to 2008. J Urol. 2011 Aug;186 2 589 93. Open 4. Aoki Y, Brown HW, Brubaker L et al. Urinary incontinence in women. Nat Rev Dis Primers. 2017 Jul 6;3 17042. Open 5. John G, Bardini C, Combescure C et al. Urinary Incontinence as a Predictor of Death: A Systematic Review and Meta-Analysis. PLoS One. 2016 Jul 13;11 7):e0158992. Open 6. Yip SK, Cardozo L. Psychological morbidity and female urinary incontinence. Best Pract Res Clin Obstet Gynaecol. 2007 Apr;21 2 321 9. Open 7. Holroyd-Leduc JM, Tannenbaum C, Thorpe KE et al. What type of urinary incontinence does this woman have?. JAMA. 2008 Mar 26;299 12 1446 56. Open 8. Nambiar AK, Bosch R, Cruz F et al. EAU Guidelines on Assessment and Nonsurgical Management of Urinary Incontinence. Eur Urol. 2018 Apr;73 4 596 609. Open 9. Mary Ann Barnes, Jessica Bennett, Jennifer Ross et al. Single-Point Acupuncture for Treatment of Urge Incontinence in Women: A Pilot Nonrandomized Trial. Med Acupunct. 2018 Feb 1;30 1 21 24. Open https://web.pathway.md/diseases/recIQCZOhn8GVw9eC 3/4 6/29/23, 3:49 AM Urinary incontinence in women Pathway 10. Expert Panel on GYN and OB Imaging: Gaurav Khatri, MD, Priyadarshani R. Bhosale et al. American College of Radiology ACR Appropriateness Criteria Pelvic Floor Dysfunction in Females. ACR. 2021. Open 11. S. Gravas, J.N. Cornu, M. Gacci et al. EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms LUTS , incl. Benign Prostatic Obstruction BPO . EAU. 2022 Mar. Open https://web.pathway.md/diseases/recIQCZOhn8GVw9eC 4/4