Chapter 35: Urinary Incontinence

INTRODUCTION

Urinary incontinence is a common and potentially debilitating condition. It affects about 10%–40% of adult women and is considered severe in approximately 3%–17%.¹ The true magnitude of this problem is unknown due to underreporting. About 60%–75% of incontinent patients do not seek treatment for their condition because of embarrassment, the belief that incontinence is a normal condition of aging, fear of needing surgery, the lack of knowledge about the treatments available, and skepticism about the effectiveness of the available therapies.^2,3,4,5,6,7 The World Health Organization has identified urinary incontinence as an important global health issue.

Although urinary incontinence usually does not affect a woman’s physical well-being, it creates a significant social problem. Urinary incontinence has been found to reduce social interactions and physical activities and is associated with poor health, impaired emotional and psychological well-being, and interference with sexual relations.^8,9,10,11 In older patients, urinary incontinence doubles the risk of injury and bone fracture from falling and being admitted to a nursing home.^12,13 Because of these reasons, clinicians should routinely screen all their female patients for this prevalent condition.

Urinary incontinence in overweight and obese patients is evaluated and managed in a similar fashion as their normal-weight counterparts.^{14,15,16,17,18} The efficacy of available treatments for urinary incontinence is determined almost exclusively from randomized controlled trials (RCTs) that included patients from all weight classes. The evaluation and treatment presented are based on findings from these trials with minor modifications for overweight and obese patients. Emphasis is on these modifications when applicable.

EVALUATION

Although urinary incontinence may be caused by numerous conditions, almost all incontinent patients seen by clinicians have either stress urinary incontinence (SUI), overactive bladder (OAB), or both, which account for about 50%, 25%, and 25% of the incontinent cases, respectively.¹⁹ The initial evaluation of an incontinent patient is relatively straightforward. In addition to the standard history and physical examination used to evaluate any new gynecologic patient, we also assess the impact of urinary incontinence on the patient’s quality of life (QoL); determine whether the patient has SUI, OAB, or both; and inquire about previous treatments.

Impact of Urinary Incontinence on Quality of Life

Urinary incontinence frequently has a negative effect on the patient’s QoL, which is the major factor that determines whether she seeks care for her condition and the intensity of evaluation and treatment. Consequently, QoL assessment is an important part of evaluating urinary incontinence. For busy clinicians, the most convenient method to perform this assessment is to use one of the validated questionnaires designed to evaluate the impact of incontinence symptoms on a patient’s QoL. At my facility, we use the International Consultation on Incontinence Modular Questionnaire—Urinary ...