Urinary Incontinence  Involuntary loss of urine due to dysfunction of bladder storage, outlet control, or both. Classified as stress, urge (overactive bladder), overflow, functional, or mixed types. Very common in women after menopause or childbirth.

Urinary Incontinence 
<ul> 
<li>Involuntary loss of urine due to dysfunction of bladder storage, outlet control, or both. Classified as stress, urge (overactive bladder), overflow, functional, or mixed types.</li> 
<li>Very common in women after menopause or childbirth. Overflow type occurs more often in men with benign prostatic hyperplasia or neurologic disease.</li> 
</ul> 
Clinical Presentation 
<ul> 
<li> 
Stress Incontinence: Leakage with increased intra-abdominal pressure (cough, sneeze, laugh); common postpartum or post-menopause. 
The question stem would likely describe a postmenopausal woman who reports urine leakage when she exercises, laughs, or coughs. 
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<li> 
Urge Incontinence: Sudden, strong urge to void with inability to reach the toilet in time; caused by overactive detrusor muscle; nocturia is common. 
The question stem would likely describe a patient who feels an abrupt urge to urinate and cannot make it to the bathroom in time, often awakening several times at night. 
</li> 
<li> 
Overflow Incontinence: Dribbling and incomplete emptying due to bladder outlet obstruction or detrusor underactivity; seen with benign prostatic hyperplasia, neurogenic bladder, or diabetes. 
The question stem would likely describe an older man with benign prostatic hyperplasia who reports dribbling urine and a sensation of incomplete emptying. 
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<li> 
Functional Incontinence: Normal bladder function but impaired mobility or cognition (dementia, post-stroke). 
The question stem would likely describe an elderly nursing home resident with dementia who is unable to reach the bathroom before urinating. 
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<li> 
Mixed Incontinence: Combination of stress and urge symptoms; common in older women. 
The question stem would likely describe an older woman with both leakage when coughing and episodes of urgency. 
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</ul> 
Diagnostics 
<ul> 
<li>Urinalysis and urine culture: First step to rule out urinary tract infection.</li> 
<li>Serum BUN and creatinine: Assess renal function in chronic or severe cases.</li> 
<li>Post-void residual measurement: 
<ul> 
<li>Less than 50 mL is normal.</li> 
<li>Greater than 200 mL suggests overflow incontinence.</li> 
<li>In older adults, a residual up to about 100 mL can be normal.</li> 
</ul> 
</li> 
<li>Bladder stress (cough) test: With a full bladder, immediate leakage after a single cough confirms stress incontinence.</li> 
<li>Voiding diary (48–72 hours) and medication review: Identify transient or medication-related causes (e.g., diuretics, anticholinergics, calcium-channel blockers, opioids, alpha-blockers).</li> 
<li>Urodynamic studies: A small catheter measures bladder pressure and urine flow during filling and emptying; used to identify detrusor overactivity, impaired contractility, or outlet obstruction when the diagnosis is uncertain or before surgery.</li> 
<li>Neurologic evaluation: Consider if diabetic neuropathy or spinal cord involvement is suspected.</li> 
</ul> 
Treatment 
Step 1: Behavioral and Lifestyle Measures 
<ul> 
<li>Bladder training: Scheduled voiding at gradually longer intervals to increase bladder capacity and reduce urgency episodes.</li> 
<li>Timed voiding and fluid management; limit caffeine, alcohol, and bladder irritants.</li> 
<li>Kegel (pelvic floor) exercises for stress incontinence.</li> 
<li>Weight loss and smoking cessation.</li> 
<li>Topical vaginal estrogen for postmenopausal atrophic urethritis or vaginitis contributing to symptoms.</li> 
</ul> 
Step 2: Pharmacologic Management (Type-Specific) 
<ul> 
<li>Urge / Overactive bladder: 
<ul> 
<li>Antimuscarinic agents (oxybutynin,

Physician Assistant Exam Review

143 Bladder disorders – How you’ll see them on your exam

143 Bladder disorders – How you’ll see them on your exam

Description