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The management of urinary incontinence in women

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Urinary incontinence describes involuntary leakage of urine. Urinary incontinence is more prevalent in women than men with an increasing incidence with advancing age.1 Stress urinary incontinence refers to involuntary leakage of urine on effort or exertion whereas urge urinary incontinence refers to involuntary leakage of urine that is associated with or preceded by a sudden desire to pass urine.1

Mixed urinary incontinence occurs when stress and urge urinary incontinence co-exist. Overactive bladder syndrome (OAB) may cause urge urinary incontinence. This usually presents with increased frequency and nocturia.2 Involuntary detrusor contractions (spontaneous or provoked) that may be observed on urodynamic studies are known as detrusor overactivity.

History taking
When evaluating urinary incontinence, the cause may be apparent and there may be pre-existing factors responsible. For example, constipation, obesity, diabetes, alcohol and high fluid intake may be relevant.

It is important to assess the severity of incontinence and its impact on quality of life. Severity may be assessed by asking the patient when incontinence occurs and whether there is an activity that precipitates it. The patient may be using pads to self-manage her symptoms and may be restricting fluid intake. Furthermore there may be an effect on the patient's social life and/or sexual function.

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