Differential Diagnosis for Urinary Incontinence
The patient presents with symptoms of urinary incontinence, including intermittent leaking of urine and a feeling of incomplete bladder emptying. The following differential diagnoses are considered:
- Single most likely diagnosis
- Uterine fibroids with associated urinary retention and overflow incontinence: The patient's physical examination reveals an enlarged uterus with multiple irregular protrusions, consistent with uterine fibroids. The fibroids may be compressing the bladder or urethra, leading to urinary retention and subsequent overflow incontinence.
- Other Likely diagnoses
- Stress urinary incontinence: The patient has a history of three term vaginal deliveries, which increases her risk of stress urinary incontinence. However, her symptoms of intermittent leaking and feeling of incomplete bladder emptying are not typical of stress urinary incontinence.
- Mixed urinary incontinence: The patient's symptoms could also be consistent with mixed urinary incontinence, which is a combination of stress and urge urinary incontinence. However, the absence of dysuria or pelvic pain makes this diagnosis less likely.
- Diuretic-induced incontinence: The patient takes a thiazide diuretic for chronic hypertension, which may contribute to her incontinence. However, this is unlikely to be the primary cause of her symptoms.
- Do Not Miss diagnoses
- Uterine cancer: Although less likely, uterine cancer could present with similar symptoms, including an enlarged uterus and irregular protrusions. It is essential to rule out this diagnosis with further evaluation.
- Neurogenic bladder: A neurogenic bladder could cause urinary retention and overflow incontinence. However, the patient's symptoms and physical examination do not suggest a neurologic cause.
- Rare diagnoses
- Urethral diverticulum: A urethral diverticulum is a rare condition that could cause urinary incontinence. However, it is unlikely in this patient, given the absence of other symptoms such as dysuria or pelvic pain.
- Bladder outlet obstruction: Bladder outlet obstruction is a rare cause of urinary incontinence in women. However, it could be considered in this patient, given her symptoms of incomplete bladder emptying.