Prevalence and risk factors – Female urinary incontinence is common. While the prevalence varies by population being studied, up to 60 percent of reproductive-age females have reported urinary incontinence at any one time. Risk factors for urinary incontinence include obesity, vaginal parity, older age, and family history.
●Types of female urinary incontinence – The major clinical types of urinary incontinence are stress urinary incontinence (SUI; leakage with maneuvers that increase intra-abdominal pressure), urgency urinary incontinence (sudden urgency followed by leakage), mixed urinary incontinence (symptoms of both stress and urgency), and overflow incontinence. "Overactive bladder" is a term that describes a syndrome of urinary urgency, with or without incontinence.
Other etiologies for urinary incontinence in women include other less common urologic or gynecologic disorders (eg, urogenital fistulas, cancer), neurologic diseases (eg, multiple sclerosis), and potentially reversible causes (eg, medications).*
●Initial evaluation – The initial evaluation of urinary incontinence includes characterizing and classifying the type of incontinence, identifying underlying conditions (eg, neurologic disorder or malignancy) that may manifest as urinary incontinence, and identifying potentially reversible causes of incontinence. This evaluation includes a thorough history, urinalysis, and physical examination when appropriate. (See 'Evaluation' above.)
•History – The history classifies and prioritizes the patient's urinary symptoms, as well as identifies other symptoms that indicate the need to evaluate further for underlying causes of incontinence due to serious conditions or potentially reversible medical or functional conditions. (See 'History' above.)
•Role of pelvic examination – Women presenting with complicated symptoms of urinary incontinence or who fail initial behavioral and medical treatments should have a pelvic examination. Additionally, a patient's history may suggest other components of the physical examination that are important in diagnosis. (See 'Physical examination' above.)
•Urinalysis and urine culture – A urinalysis should be performed in all patients. If a urinary tract infection (UTI) is suspected, then a urine culture is obtained. (See 'Laboratory tests' above.)
•Clinical tests – A bladder stress test is used to diagnose SUI. Postvoid residual (PVR) volume and urodynamic testing are not required for initiation of treatment. (See 'Clinical tests' above.)
●Specialist referral – Referral to a specialist is indicated in a minority of cases: incontinence with abdominal/pelvic pain or hematuria in the absence of UTI, suspected vesicovaginal fistula, abnormal physical examination findings (eg, pelvic organ prolapse beyond the hymen), new neurologic symptoms in addition to urinary and/or bowel incontinence or suspected overflow incontinence. Women with three or more culture-proven UTIs in a year or at least two in six months warrant referral to a specialist. (See 'Specialist referral' above.)
