From the Guidelines
To evaluate new urinary incontinence in a 61-year-old female with no history of cancer, begin with a comprehensive history and physical examination, followed by urinalysis and measurement of post-void residual volume. The history should focus on the type, frequency, and severity of incontinence episodes, along with aggravating factors like coughing or sneezing, as suggested by 1. Ask about fluid intake patterns, medications, medical conditions, obstetric history, and previous pelvic surgeries. Physical examination should include abdominal, pelvic, and neurological assessments, checking for pelvic organ prolapse, vaginal atrophy, and pelvic floor muscle strength.
Initial Evaluation Steps
- A voiding diary for 3-7 days is valuable to document frequency, volume, and circumstances of leakage.
- Laboratory tests should include urinalysis to rule out infection or hematuria, and blood glucose to exclude diabetes, as recommended by 1.
- Measuring post-void residual volume via bladder scan or catheterization helps identify overflow incontinence.
- For stress incontinence, a cough stress test can be performed.
Advanced Testing
More advanced testing like urodynamics, cystoscopy, or imaging may be indicated if initial evaluation suggests complicated causes or if initial management fails, as indicated by 1. These steps help distinguish between stress, urge, mixed, or overflow incontinence, which guides appropriate treatment options including behavioral modifications, pelvic floor exercises, medications, or referral to urology or urogynecology for specialized care. The most recent guidelines from 1 emphasize the importance of a tailored approach to managing stress urinary incontinence, considering the patient's individual characteristics, preferences, and severity of symptoms.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Evaluation Steps
The evaluation of new urinary incontinence in a 61-year-old female with no history of cancer involves several steps, including:
- A thorough history to identify symptoms of different subtypes of urinary incontinence, such as stress, urge, mixed stress/urge, and overflow, as well as information about comorbid conditions, incontinence frequency and severity, and effect on quality of life 2
- A physical examination, including a pelvic examination, to assess for any underlying conditions that may be contributing to the incontinence 2, 3
- Urinalysis to rule out any underlying urinary tract infections or other conditions that may be causing the incontinence 2, 4
- Measurement of postvoid residual urine volume to assess for any obstruction or detrusor hypoactivity 2, 4
- A voiding diary to track the patient's fluid intake, urine output, and episodes of incontinence 2
- Urinary stress testing to assess for stress incontinence 2
Additional Testing
If the initial evaluation is inconclusive, or if the patient's symptoms persist despite initial treatment, additional testing may be necessary, including:
- Multi-channel urodynamic testing to assess the patient's bladder function and identify any underlying conditions that may be contributing to the incontinence 3
- Referral to a urodynamic laboratory for further testing and evaluation 3
- Specialty treatment, such as pelvic floor physical therapy, or surgical interventions, such as placement of midurethral slings 2, 5
Treatment Options
Treatment options for urinary incontinence in a 61-year-old female with no history of cancer may include:
- Lifestyle modifications, such as decreasing caffeine intake, engaging in physical activity to strengthen pelvic floor muscles, and avoiding excessive fluid consumption 2, 6
- Behavioral therapies, such as timed or prompted voiding, and pelvic floor exercises 2, 5
- Pharmacotherapy, such as anticholinergic drugs or beta-3 adrenergic agonists, for urge incontinence 2
- Surgical interventions, such as placement of midurethral slings, for stress incontinence 2