![]() ![]() ![]() Complete loss of sphincter function (due to previous surgery, nerve damage, metastasis) or abnormal anatomy ( fistula between urinary tract and skin).Treat the most bothersome symptom first, e.g., anticholinergics for urge incontinence. ![]() May have any of the clinical features above.Combination of mechanisms of stress incontinence and urge incontinence.See “ Treatment of urge incontinence” for additional information.Second line: interventional procedures (e.g., sacral nerve stimulation, injection of botulinum toxin into the bladder wall).Strong, sudden sense of urgency, followed by involuntary leakage.Inflammatory conditions (e.g., UTI ) or neurogenic disorders → sphincter dysfunction, detrusor overactivity, or overactive bladder → autonomous contractions of the detrusor muscle and premature initiation of a normal micturition reflex.See “ Treatment of stress incontinence” for additional information.Surgical procedures (e.g., urethral slings or suspensions, artificial urinary sphincter).Injection of periurethral bulking agents.Minimally-invasive solutions, e.g., vaginal pessaries or urethral inserts.In refractory or severe incontinence, refer to urology for:.Trial of conservative management of UI for 6–8 weeks.Positive bladder stress test : urinary leakage during activities that increase intraabdominal pressure (e.g., coughing, Valsalva maneuver).Increase in intraabdominal pressure (e.g., from laughing, sneezing, coughing, exercising) → ↑ pressure within the bladder → bladder pressure > urethral sphincter resistance to urinary flow.Intrinsic sphincter deficiency, caused by:.Childbirth (i.e., damage of the pelvic floor muscle levator ani and/or the S2 – S4 nerve roots ).Poor pelvic support caused by pelvic postmenopausal estrogen loss. ![]()
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