From the Guidelines
The workup for new primary urinary incontinence in a 61-year-old female should begin with a thorough history and physical examination to determine the type of incontinence (stress, urge, mixed, or overflow). Ask about onset, frequency, severity, and associated symptoms like dysuria or hematuria. Obtain a complete medication history as some drugs can cause or worsen incontinence. Perform a focused physical exam including pelvic examination to assess for pelvic organ prolapse, vaginal atrophy, and pelvic floor strength. Initial testing should include urinalysis to rule out infection or hematuria, post-void residual measurement to assess for retention, and a voiding diary for 3-7 days to document frequency, volume, and circumstances of leakage. Basic blood tests including glucose, BUN, and creatinine are appropriate to screen for conditions like diabetes or renal dysfunction. For stress incontinence, a cough stress test can be performed. More advanced testing may include urodynamic studies if the diagnosis remains unclear or if initial management fails. Imaging is not routinely needed unless complications are suspected. This systematic approach helps identify the specific type of incontinence and any contributing factors, allowing for targeted treatment which may include behavioral modifications, pelvic floor exercises, medications, or referral to urology or urogynecology for specialized management, as supported by recent reviews on the management of stress urinary incontinence in women 1.
Some key points to consider in the workup and management of urinary incontinence include:
- The importance of a thorough history and physical examination to guide the diagnostic process and treatment plan.
- The use of urinalysis, post-void residual measurement, and voiding diary as initial diagnostic tests.
- The consideration of pelvic floor muscle training as a first-line management strategy for stress urinary incontinence, as highlighted in recent reviews 1.
- The potential role of surgical interventions, such as midurethral slings, for women with stress incontinence who do not respond to conservative management, as discussed in the literature 1.
- The need for individualized treatment approaches, taking into account patient preferences, symptoms, and quality of life, as emphasized in guidelines and reviews on the topic 1.
By following this systematic approach and considering the latest evidence and guidelines, healthcare providers can provide effective and personalized care for women with urinary incontinence, improving their quality of life and reducing the burden of this condition.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Initial Evaluation
The initial evaluation of a 61-year-old female with new primary urinary incontinence and no history of cancer should include:
- Determining whether incontinence is transient or chronic 2
- Identifying the subtype of incontinence (stress, urge, mixed, or other) 3, 4
- Identifying any red flag findings that warrant subspecialist referral, such as significant pelvic organ prolapse or suspected fistula 2
Diagnostic Tools
Helpful tools during initial evaluation include:
- Incontinence screening questionnaires 2
- A three-day voiding diary 2
- The cough stress test 2
- Measurement of postvoid residual 2
- Urinalysis, which should be ordered for all patients 2
- A thorough physical examination, including all relevant gynecologic and neurologic aspects, such as the Q-tip test 4
Treatment Approach
A step-wise approach to treatment is directed at the urinary incontinence subtype, starting with:
- Conservative management, including lifestyle modifications (e.g., appropriate fluid intake, smoking cessation, and weight loss) and pelvic floor strengthening exercises 5, 2, 6
- Escalating to physical devices and medications, such as antimuscarinic medications and mirabegron for urge incontinence 2
- Referring for surgical intervention if necessary, with a variety of treatment options available, including approximately 200 different surgical procedures for stress urinary incontinence 6