Urinary Incontinence

UrinaryIncontinenceManagementSummaryIs there a specific treatable cause?• Does the patient have a UTI? If yes, treat patient for at least 7 days with appropriate antibiotic andthen reassess symptoms.• Does the patient have a urological or gynecological cause (e.g., enlarged prostate, prolapse) thatneeds a referral?Are there treatable contributing factors?• Is the patient taking medications that could aggravate the problem (loop diuretics, benzodiazepines,calcium channel blockers, alpha-blockers or agonists, ACE inhibitors, or antihistamines)? If so, cananother medicine be substituted?• Is the patient’s liquid or alcohol intake too high? Is the patient drinking caffeinated beverages?• Does the patient have impaired mobility or cognitive impairment?• Does the patient have stress incontinence (leakage with coughing, laughing, bending, sneezing)or urge incontinence (leakage with sudden overwhelming urgency)? If yes, consider behavioraltreatment.• If the patient does not respond to initial behavioral therapy, consider referral for biofeedback. If theystill don’t respond and they have urge incontinence, consider bladder relaxant therapy. If they havestress incontinence, consider urology or gynecology referral. This can also be considered for patientswith urge incontinence who do not respond to medications.• If all else fails or patient prefers no behavioral, medical, or surgical treatment, consider continenceproducts, such as diapers (give community resources).