Symptoms of Lower Urinary Tract Dysfuntion - Urinary Incontinence
- The lower urinary tract comprises the bladder and urethra and should be considered as a single functioning vesicourethral unit required to store urine and empty efficiently.
- Dysfunction occurs when there is a breakdown in this funtional unit, resulting in storage and/or voiding symptoms, urinary retention, or incontinence.
- The “storage” component of lower urinary tract symptoms (LUTS), where incontinence is he most bothersome, is a common and important cause of morbidity and impairment of quality of life, in both men and women. (Chapple et al, 2008).
Signs and Symptoms of Urinary Incontinence
The International Continence Society (ICS) has defined the symptom of UI as the complaint of any involuntary loss of urine that is a social or hygienic problem.
Stress UI -
- Symptomatic complaint of involuntary leakage on effort or exertion, or on sneezing or coughing.
- Sign of involuntary urinary loss from the urethra synchronous with exertion, sneezing, or coughing.
- Urodynamic diagnosis of the involuntary leakage of urine during increases in abdominal pressure in the absence of a detrusor contraction—or called urodynamic stress incontinence.
Urgency UI- a symptom of Overactive Bladder
- Symptomatic complaint of involuntary leakage accompanied by or immediately preceded by urgency as contrasted to urge, which is a normal sensation.
- Sign of involuntary urinary loss from the urethra that is accompanied by or immediately preceded by urgency.
- Urodynamic diagnosis of incontinence related to an involuntary detrusor contraction during urodynamics—so-called detrusor overactivity associated incontinence.
Mixed UI -
- A symptomatic complaint of involuntary leakage associated with urgency and also with exertion, effort, sneezing, or coughing.
- A sign of involuntary urinary loss from the urethra synchronous with exertion, sneezing, or coughing and of involuntary urinary loss from the urethra that is accompanied by or immediately preceded by urgency.
- Urodynamic diagnosis of both involuntary leakage of urine during increases in abdominal pressure. It is related to an involuntary detrusor contraction during urodynamics and is present in approximately 40% of women with stress incontinence.
Patient History
History should include:
- Presence or absence, incidence, severity, bother and effect on quality of life of urgency incontinence or stress incontinence.
- Other LUTS should also be assessed.
- Presence or absence of dysuria and hematuria.
- Whether occult neurologic disease could be present.
- Obstetric and gynecologic history, previous surgery/radiotherapy, bowel symptoms, and drug history.
- Other medical issues
- Focused physical examination requires abdominal and pelvic examination, as well as basic neurologic examination. Assessment of bladder emptying is necessary done by palpating the lower abdomen.
- Urinalysis in all patients.
- The algorithms from the fourth International Consultation on Incontinence 2008 summarize the basic assessment necessary in the evaluation of lower urinary tract dysfunction in men, women, and the frail elderly.
The consequences of UI lead to serious morbidity, including falls and fractures, urinary tract infections, skin breakdown including pressure ulcers, and admission to nursing homes.
- UI is not a highly progressive disease.
- Conservative therapies are effective, well tolerated, safe, and preferred by many patients.
- It is generally appropriate that the least invasive treatment that takes into account patient preferences and offers a reasonable chance for success be used first.
- Although it is important to rule out serious underlying or associated conditions, invasive testing is rarely required before initiating treatment with conservative measures.
References:
- Abrams P, Artibani W, Cardozo L, et al: Reviewing the ICS 2002 terminology report: the ongoing debate. Neurourol Urodyn 2009; 28(4):287.
- Abrams P, Cardozo L, Fall M, et al: The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21(2):167-178.
- Abrams P, Cardozo L, Khoury S, Wein A, ed. Incontinence, 4th ed. Plymouth (MA): Health Publications Ltd; 2009.
- Sexton CC, Coyne KS, Kopp Z, et al: The overlap of storage, voiding and postmicturition symptoms and implications for treatment seeking in the USA, UK and Sweden: EpiLUTS. BJU Int 2009; 103(Suppl. 3):12-23.