Differential Diagnosis for Urinary Incontinence
Single Most Likely Diagnosis
- Stress Urinary Incontinence (SUI): This condition is characterized by the involuntary leakage of urine on effort or exertion, or on sneezing or coughing. Given the patient's symptoms of incontinence while running for a bus and coughing, SUI is the most likely diagnosis. The patient's history of multiple childbirths also increases her risk for SUI due to potential pelvic floor muscle weakness.
Other Likely Diagnoses
- Urge Urinary Incontinence (UUI): Although the patient's symptoms are more suggestive of SUI, UUI, characterized by the involuntary leakage accompanied by or immediately preceded by urgency, cannot be ruled out without further evaluation. Mixed Urinary Incontinence (MUI), which combines symptoms of SUI and UUI, is also a possibility.
- Overactive Bladder (OAB): This condition is characterized by urgency, with or without urge incontinence, usually with frequency and nocturia. While the primary complaint is incontinence during exertion, OAB could be a contributing factor if the patient experiences urgency.
Do Not Miss Diagnoses
- Neurogenic Bladder: Although less likely, neurogenic bladder due to conditions like multiple sclerosis, spinal cord injury, or diabetic neuropathy could lead to urinary incontinence. Missing this diagnosis could lead to significant morbidity.
- Pelvic Organ Prolapse: Severe prolapse can cause urinary incontinence, and while it might not directly cause incontinence during coughing or running, it's a condition that needs to be considered to provide comprehensive care.
- Urinary Tract Infection (UTI) or other infections: UTIs can cause or exacerbate urinary incontinence. Failing to diagnose and treat a UTI could lead to worsening symptoms and potential complications like pyelonephritis.
Rare Diagnoses
- Fistula: A vesicovaginal fistula, although rare, could cause continuous urinary incontinence. This condition is more likely in someone with a history of pelvic surgery, radiation, or obstetric trauma.
- Detrusor Instability: Now more commonly referred to as overactive bladder, but in the context of looking for rare causes, other specific detrusor dysfunctions could be considered, especially if there's a neurological component.