Urinary incontinence: Diagnosis, treatment, and avoiding complications

Urinary incontinence is defined as the complaint of involuntary leakage of urine. Urinary incontinence impacts physical, psychological, and social well-being. In order to achieve an accurate diagnosis, a detailed history and physical exam are important. An initial evaluation should include a detailed history, urinalysis, cough stress test, evaluation of post-void residual, focused neurologic assessment, and examination for urethral hypermobility and pelvic organ prolapse. Urodynamic testing and cystoscopy may be indicated in some patients. Treatment varies based on the type of urinary incontinence and symptom severity. First-line therapy should always consist of less invasive and more conservative treatment options as they have been shown to be highly effective with minimal risk. These therapies include pelvic floor exercises, biofeedback, bladder training, weight loss, modification in fluid and caffeine intake, urethral inserts, and incontinence pessaries. Depending on the type of incontinence characterized, more invasive treatment options can be implemented if no improvement with conservative management. Typically, women with stress incontinence who have failed conservative therapies are offered surgical intervention, whereas women with urgency incontinence may be treated with pharmacologic management, intradetrusor onabotulinum toxin A, or neuromodulation. Most incontinence can be made better with available therapies.