Diagnosis is based on a thorough and focused history and physical. This process can help to determine the type of incontinence as well as its severity, duration, and burden on the patient and/or caregiver. Patient diaries of urinary incontinence can help to identify triggers, severity, and duration. Emergent conditions and potentially reversible causes may be identified. The aggressiveness of treatment may be determined by the severity of symptoms.

Medical conditions can contribute to risk factors and should be reviewed during diagnosis. Searching for reversible causes and those that can be managed can help to diminish urinary incontinence burden. Medical conditions, such as chronic obstructive pulmonary disease and asthma can increase coughing. Congestive heart failure is associated with fluid overload and diuresis. Neurologic conditions can suggest problems with innervation of the bladder for normal urination. Musculoskeletal conditions and cognitive deficits can contribute to toileting barriers. Other conditions may contribute to urinary incontinence, such as neurologic conditions (spinal cord injuries, multiple sclerosis, stroke, normal pressure hydroencephalus, spinal stenosis), renal or ureteral calculi (kidney or urethra stones), intraabdominal or pelvic masses, and anatomic abnormalities (urogenital fistulas, diverticula, ectopic ureters).

Surgical history can uncover the potential for of nerve damage. A gynecologic history for women includes the number of births, whether those were vaginal or by c-section, and whether or not the woman is currently pregnant. Estrogen status can be assessed to identify reversible urinary incontinence that is due to atrophic vaginitis and urethritis. Vaginal atrophy is the thinning, drying, and inflammation of vaginal tissues, which can lead to distressing urinary symptoms.

Medications are reviewed for those that can contribute directly or indirectly to urinary incontinence. Substance use can also increase risk for urinary incontinence. Direct impact examples are diuretics, alcohol, and caffeine. Some medications and substances may indirectly contribute to urinary incontinence, including those that result in cognitive impairment, changes in bladder tone or sphincter function, increased diuresis, and coughing.

Physical assessment related to medical conditions can help to find specific risk factors that may respond to treatment. For instance, edema associated with cardiovascular disease and cough associated with pulmonary disease can be treated to reduce the risk for urinary incontinence.

Some lab tests may be helpful and the need for these will likely be based on the assessments discussed. For instance, it is appropriate to have a urinalysis to assess urinary tract infection. If obstruction is suspected, blood urea nitrogen and creatinine may be tested to assure renal function. If overflow incontinence is suspected, a bladder ultrasound can be performed after urination to detect remaining urine and/or a renal ultrasound may be considered to rule out hydronephrosis (swelling of the kidney due to the build of urine that can’t drain from the kidney).

Urinary Incontinence: Complications

What makes urinary incontinence so much more important (to at least adequately manage) is the potential for both physical and psychological complications. For instance, not only can urinary tract infections lead to incontinence, but inadequate bladder emptying increases risk for urinary tract infections. Obstructive uropathy, which is a condition that requires urgent medical attention, can lead to renal dysfunction. Cellulitis and pressure ulcers can result from the constant exposure of skin to moisture. Behavioral complications may include decreases in physical activity, which tend to worsen incontinence symptoms even further.

Embarrassment and fear of urinary incontinence may lead to avoidance and abstinence from sex in women. There may be some fear of getting too far from a toilet for patients with urge incontinence. Urinary incontinence can also lead to depression and social isolation. For older adults, rushing to the toilet may increase the risk for falls and fractures. Finally, urinary incontinence in patients requiring caregiver services can significantly increase caregiver burden for management.