Editing Urinary incontinence (section)

==Diagnosis==
[[File:Ultrasound of trabeculated urinary bladder.jpg|alt=Ultrasound of the urinary bladder|thumb|upright=1.4|Ultrasound of the urinary bladder of an 85-year-old man. It shows a trabeculated wall, which is a sign of [[urinary retention]].]]
The pattern of voiding and urine leakage is important as it suggests the type of incontinence. Other points include straining and discomfort, use of drugs, recent surgery, and illness.{{citation needed|date=June 2022}}

The [[physical examination]] looks for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.{{citation needed|date=June 2022}}

Other tests include:<ref>{{Cite web | vauthors = Lukacz ES | date = 2 August 2023 | veditors = Schmader KE, Law K | title=Evaluation of Females with Urinary Incontinence|url=https://www.uptodate.com/contents/evaluation-of-females-with-urinary-incontinence|website=UptoDate}}</ref>
* [[Stress testing|Stress test]]&nbsp;– the patient relaxes, then coughs vigorously as the doctor watches for loss of urine.
* [[Urinalysis]]&nbsp;– urine is tested for evidence of infection, urinary stones, or other contributing causes.
* [[Blood test]]s&nbsp;– blood is taken, sent to a laboratory, and examined for substances related to causes of incontinence.
* [[Ultrasound]]&nbsp;– sound waves are used to visualize the kidneys and urinary bladder, assess the capacity of the bladder before voiding, and the remaining amount of urine after voiding. This helps know if there's a problem in emptying.
* [[Cystoscopy]]&nbsp;– a thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder.
* [[Urodynamics]]&nbsp;– various techniques measure pressure in the bladder and the flow of urine.

People are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, noting times and the amounts of urine produced.

Research projects that assess the [[efficacy]] of anti-incontinence therapies often quantify the extent of urinary incontinence. The methods include the 1-h pad test, measuring leakage volume; using a voiding diary, counting the number of incontinence episodes (leakage episodes) per day; and assessing of the strength of pelvic floor muscles, measuring the maximum vaginal squeeze pressure.

=== Main types ===
There are 4 main types of urinary incontinence:
# [[Stress incontinence]], also known as effort incontinence, is essentially due to incomplete closure of the urinary sphincter, due to problems in the sphincter itself or insufficient strength of the pelvic floor muscles supporting it. This type of incontinence is when urine leaks during activities that increase intra-abdominal pressure, such as coughing, sneezing or bearing down.<ref>{{Cite web|title=Urinary incontinence: MedlinePlus Medical Encyclopedia|url=https://medlineplus.gov/ency/article/003142.htm|access-date=2021-03-31| work = MedlinePlus | publisher = U.S. National Library of Medicine |language=en}}</ref>
# [[Urge incontinence]] is an involuntary loss of urine occurring while suddenly feeling the need or urge to urinate, usually secondary to [[Overactive bladder|overactive bladder syndrome]].
# [[Overflow incontinence]] is the incontinence that happens suddenly without feeling the urge to urinate and without necessarily doing any physical activities. It is also known as under-active bladder syndrome. This usually happens with chronic obstruction of the bladder outlet or with diseases damaging the nerves supplying the urinary bladder. The urine stretches the bladder without the person feeling the pressure, and eventually, it overwhelms the ability of the urethral sphincter to hold it back.<ref>{{Cite web|title=Overflow Incontinence | work = Michigan Medicine|url=https://www.uofmhealth.org/health-library/uh1227 |access-date=2020-05-08}}</ref>
# [[Mixed incontinence]] contains symptoms of multiple other types of incontinence. It is not uncommon in the elderly female population and can sometimes be complicated by [[urinary retention]].

=== Other types ===
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* [[Functional incontinence]] occurs when a person recognizes the need to urinate but cannot make it to the bathroom. The loss of urine may be large. There are several causes of functional incontinence including confusion, dementia, poor eyesight, mobility or dexterity, unwillingness to use the toilet because of depression or anxiety or inebriation due to alcohol.<ref name="au">{{cite web|title=Functional incontinence|url=http://www.health.gov.au/internet/main/publishing.nsf/Content/continence-what-functional.htm|year=2008|publisher=Australian Government Department of Health and Ageing|archive-url=https://web.archive.org/web/20080723150611/http://health.gov.au/internet/main/publishing.nsf/Content/continence-what-functional.htm <!-- Bot retrieved archive -->|archive-date=2008-07-23|access-date=2008-08-29}}</ref>  Functional incontinence can also occur in certain circumstances where no biological or medical problem is present. For example, a person may recognize the need to urinate but may be in a situation where there is no toilet nearby or access to a toilet is restricted.
* Structural incontinence: Rarely, structural problems can cause incontinence, usually diagnosed in childhood (for example, an [[ectopic ureter]]). [[Fistula]]s caused by obstetric and gynecologic trauma or injury are commonly known as [[obstetric fistula]]s and can lead to incontinence. These types of vaginal fistulas include, most commonly, vesicovaginal fistula and, more rarely, ureterovaginal fistula. These may be difficult to diagnose. The use of standard techniques along with a [[vaginogram]] or radiologically viewing the [[vaginal vault]] with instillation of contrast media.<ref name="pmid7265431">{{cite journal | vauthors = Macaluso JN, Appell RA, Sullivan JW | title = Ureterovaginal fistula detected by vaginogram | journal = JAMA | volume = 246 | issue = 12 | pages = 1339–1340 | date = September 1981 | pmid = 7265431 | doi = 10.1001/jama.246.12.1339 }}</ref>
* [[Nocturnal enuresis]] is episodic UI while asleep. It is normal in young children.
* Transient incontinence is temporary incontinence most often seen in pregnant women when it subsequently resolves after the birth of the child.<ref name="SangsawangSangsawang2013">{{cite journal | vauthors = Sangsawang B, Sangsawang N | title = Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment | journal = International Urogynecology Journal | volume = 24 | issue = 6 | pages = 901–912 | date = June 2013 | pmid = 23436035 | pmc = 3671107 | doi = 10.1007/s00192-013-2061-7 }}</ref>
* [[Giggle incontinence]] is an involuntary response to laughter. It usually affects children.
* Double incontinence. There is also a related condition for [[defecation]] known as [[fecal incontinence]]. Due to involvement of the same muscle group ([[levator ani]]) in bladder and bowel continence, patients with urinary incontinence are more likely to have fecal incontinence in addition.<ref name="Shamliyan 2007">{{cite journal | vauthors = Shamliyan T, Wyman J, Bliss DZ, Kane RL, Wilt TJ | title = Prevention of urinary and fecal incontinence in adults | journal = Evidence Report/Technology Assessment | issue = 161 | pages = 1–379 | date = December 2007 | pmid = 18457475 | pmc = 4781595 }}</ref>  This is sometimes termed "double incontinence".
* [[Post-void dribbling]] is the phenomenon where urine remaining in the urethra after voiding the bladder slowly leaks out after urination.
* [[Coital incontinence]] (CI) is urinary leakage that occurs during either [[coitus|penetration]] or [[orgasm]] and can occur with a sexual partner or with [[masturbation]]. It has been reported to occur in 10% to 24% of sexually active women with pelvic floor disorders.<ref>{{cite web | vauthors = Karlovsky ME | url = http://www.femalepatient.com/html/arc/sig/uroG/articles/034_08_032.asp | archive-url = https://web.archive.org/web/20101122151307/http://www.femalepatient.com/html/arc/sig/uroG/articles/034_08_032.asp | archive-date = 22 November 2010 | title = Female Urinary Incontinence During Sexual Intercourse (Coital Incontinence): A Review | work = The Female Patient }}</ref>
* [[Climacturia]] is urinary incontinence at the moment of orgasm. It can be a result of radical [[prostatectomy]].

===Screening===
Yearly screening is recommended for women by the Women's Preventive Services Initiative (WPSI) and people who test positive in the screening process would need to be referred for further testing to understand how to help treat their condition.<ref name="O'Reilly_2018" /><ref>{{cite journal | vauthors = Armstrong C | title = Urinary Incontinence: Screening Recommendation from the WPSI | language = en-US | journal = American Family Physician | volume = 99 | issue = 3 | pages = 194 | date = February 2019 | pmid = 30702263 | url = https://www.aafp.org/pubs/afp/issues/2019/0201/p194.html }}</ref> Screening questions should inquire about what symptoms they have experienced, how severe the symptoms are, and if the symptoms affect their daily lives.<ref name="O'Reilly_2018">{{cite journal | vauthors = O'Reilly N, Nelson HD, Conry JM, Frost J, Gregory KD, Kendig SM, Phipps M, Salganicoff A, Ramos D, Zahn C, Qaseem A | display-authors = 6 | title = Screening for Urinary Incontinence in Women: A Recommendation From the Women's Preventive Services Initiative | journal = Annals of Internal Medicine | volume = 169 | issue = 5 | pages = 320–328 | date = September 2018 | pmid = 30105360 | doi = 10.7326/M18-0595 | s2cid = 51972975 | doi-access =  }}</ref> {{as of|2018}}, studies have not shown a change in outcomes with urinary incontinence screenings in women.<ref>{{cite journal | vauthors = Nelson HD, Cantor A, Pappas M, Miller L | title = Screening for Urinary Incontinence in Women: A Systematic Review for the Women's Preventive Services Initiative | journal = Annals of Internal Medicine | volume = 169 | issue = 5 | pages = 311–319 | date = September 2018 | pmid = 30105353 | doi = 10.7326/M18-0225 | s2cid = 51971188 }}</ref>