Incontinence, urine, adult

Rationale

Incontinence has increased in frequency as our population ages. Urinary incontinence in adults often has a detrimental effect on quality of life, with significant impact on physical and psychological health.

Causal Conditions

(list not exhaustive)

1. Transient
   1. Polyuria
   2. Impaired ability to reach toilet
   3. Medications, alcohol use
2. Neurologic (e.g., cauda equina syndrome)
3. Anatomic
   1. Stress incontinence
   2. Urge incontinence (e.g., cystitis)
   3. Overflow incontinence (e.g., prostate enlargement, multiple sclerosis)
   4. Mixed incontinence

Key Objectives

Given an adult patient with urinary incontinence, the candidate will diagnose the cause, severity, and complications, and initiate an appropriate management plan. In particular, the candidate will address the two most common subtypes of urinary incontinence: stress incontinence and urge incontinence.

Enabling Objectives

Given an adult patient with urinary incontinence, the candidate will

1. list and interpret critical clinical findings, including those based on
   1. an appropriate history and physical examination, including pelvic, rectal, and neurologic examinations;
2. list critical laboratory investigations and interpret the results of the investigations, including
   1. urinalysis and culture;
3. construct an effective initial management plan, including
   1. initiating treatment for cystitis and urethritis if present,
   2. counselling the patient regarding therapeutic options (e.g., anticholinergic medication for urge incontinence) or surgical options and counselling the patient regarding quality of life and psychosocial impact, and
   3. making an appropriate referral (e.g., to an incontinence program) if indicated.