Definition: involuntary loss of urine.

Evaluation:

History: addressing any contributory factors like

1. UTI → urgency, frequency, disuria 
2. Constipation, chronic cough  (astha, COPD etc)
3. Drug history: diuretics
4. F/O hyperglycemia: polyphagia, polydipsia, polyuria
5. F/O hypercalcemia: muscle weakness, fracture, depressed mood 
6. Restricted mobility

Examination:

• Rectal examination for prostate enlargement 
•  Pelvic exaiation for vagial prolapse ad atrophic vaginitis 
• 3 days Urinary diary to establish pattern of urinary loss 

Investigation:

management:

• Lifestyle modification for all incontinence:  

1. Weight loss if obese  
2. Reduce caffeine consumption  
3. Smoking cessation  
4. Regular planned toileting   (prompted toileting in dementia)

• Treatment of contributory factor: 

1. antibiotics for infection, 
2. laxative for constipation, 
3. correction of prolapse
4. treatent of cough: astha, COPD etc 

• Urgency incontinence: 

1. Bladder retraining 
2. Antimuscarinic medications: solifenacin, tolterodine →cautio: cognitive impairment.  

• Stress incontinence:

1. Pelvic floor muscle training 
2. Surgical intervention if unsuccessful  
3. treatment of associated atrophic vaginitis →estrogen pessaries.  

• Overflow incontinence: 

1. Surgical relief of obstruction (prostatectomy) 
2. Intermittent catheterisation if no obstruction