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Urinary incontinence is the involuntary leakage of urine. It is a symptom that is often underreported by patients, and, therefore, is underdiagnosed and undertreated. It can have a significant impact on the quality of life of incontinent individuals, affecting their social, emotional, functional, and psychological well-being. There are many reversible causes of incontinence for which emergency physicians can initiate treatment and refer for specialty follow-up.


Continence is maintained through a complex interplay of neurologic and muscular structures that keep intraurethral pressure higher than intravesical pressure (Table 108.1-1).

Table 108.1-1 Muscular and Neurologic Structures Contributing to Maintenance of Urinary Continence

Clinical Features

The history, physical examination, and urinalysis are often sufficient to initiate treatment in the ED. The onset and course of symptoms, leakage frequency, associated symptoms, precipitating factors, and bowel and sexual function should be noted. The physical examination includes evaluation of cognitive and functional status, as well as neurologic and muscular, cardiovascular, abdominal, and vaginal examinations. Note the presence of any previous surgical scars. The differential diagnosis includes infection, systemic illness, neurologic disease, impaired cognition, and medication effects. Functional incontinence may be due to impaired cognition, mobility, manual dexterity, or environmental factors. Numerous medications also contribute to incontinence, especially in older individuals.

The most common types of urinary incontinence related to the lower urinary tract are listed in Table 108.1-2.

Table 108.1-2 Common Types of Lower Tract Urinary Incontinence

Urge incontinence is related to uninhibited bladder contractions (detrusor muscle overactivity). Urge incontinence is seen in women ...

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