Urinary Incontinence

Original Editor - Your name will be added here if you created the original content for this page.

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Clinically Relevant Anatomy

add text here relating to clinically relevant anatomy of the condition

Pelvic Floor

The pelvic floor is made up of the muscles, ligaments, and fascial structures that act together to support the pelvic organs and to provide compressive forces to the urethra during increased intra-abdominal pressure.

The pelvic floor muscles refers to the muscular layer of the pelvic floor.  It includes the levator ani, striated urogenital sphincter, external anal sphincter, ischiocavernosus, and bulbospongiosus. 

The urethra, vagina, and rectum pass through the pelvic floor and are surrounded by the pelvic floor muscles.  During increased intra-abdominal pressure, the pelvic floor muscles must contract to provide support.  When the pelvic floor muscles contract the urethra, anus, and vagina close.  The contraction is important in preventing involuntary loss of urine or rectal contents.  The pelvic floor muscles must also relax in order to void.

Definitions: 

• Urinary incontinence (symptom):  Complaint of involuntary loss of urine.
• Stress (urinary) incontinence:  Complaint of involuntary loss of urine on effort or physical exertion (e.g. sporting activities), or on sneezing or coughing.
• Urgency (urinary) incontinence:  Complaint of involuntary loss of urine associated with urgency.
• Mixed (urinary) incontinence:  Complaint of involuntary loss of urine associated with urgency and also effort or physical exertion or on sneezing or coughing.
• Urgency:  Complaint of a sudden, compelling desire to pass urine which is difficult to defer.
• Overactive bladder (OAB, Urgency) syndrome:  Urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology.

Clinical Presentation

add text here relating to the clinical presentation of the condition

Diagnostic Procedures

A large portion of women with urinary stress incontinence can be diagnosed from clinical history alone.

Pelvic Floor Muscle Strength
Modified Oxford grading system: 

0 - no contraction
1 - flicker
2 - weak squeeze, no lift
3 - fair squeeze, definite lift
4 - good squeeze with lift
5 - strong squeeze with a lift

Palpation of the pelvic floor muscles per the vagina in females and per the rectum in male patients.

PERFECT mnemonic assessment, described by Jo Laycock:

P - power, may use the Modified Oxford grading scale
E - endurance, the time (in seconds) that a maximum contraction can be sustained
R - repetition, the number of repetitions of a maximum voluntary contraction
F - fast contractions, the number of fast (one second) maximum contractions
ECT - every contraction timed, reminds the therapist to continually overload the muscle activity for strengthening

Outcome Measures

• Incontinence Quality of Life Instrument (I-QOL)
• Patient Global Impression of Improvement (PGI-I)
• Patient Global Impression of Severity (PGI-S)
• Pelvic Floor Distress Inventory - 20 (PFDI - 20)
• Pelvic Floor Impact Questionnaire - 7 (PFIQ - 7)

Management / Interventions

add text here relating to management approaches to the condition

Differential Diagnosis

Multi-channel urodynamics testing is the gold standard for making a condition-specific diagnosis.  This testing is typically done in secondary care, not in primary care or physical therapy.

Key Evidence

add text here relating to key evidence with regards to any of the above headings

Resources

add appropriate resources here

Case Studies

add links to case studies here (case studies should be added on new pages using the case study template)

References

References will automatically be added here, see adding references tutorial.